Medicare Prescription Drug Benefit Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
RevisionSpreadsheet2008eamg.xls	Supplementary Document	Uploaded 2008-11-10	Available
CMS-10141.Supporting Statement Part A-11-07-08.doc	Supporting Statement A	Uploaded 2008-11-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8823	Medicare Prescription Drug Benefit Program (Benes)		Modified
187165	Medicare Prescription Drug Benefit Program (Plan)	Other-Agent Compensation Information	New
187164	Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)		New

ICR Details

OMB Control No: 0938-0964	ICR Reference No: 200901-0938-003
Status: Historical Active	Previous ICR Reference No: 200609-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Prescription Drug Benefit Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/14/2009
	Date Received in OIRA: 01/14/2009
Terms of Clearance: This emergency ICR is approved for 6 months, and consistent with the information collection requirements set forth in the rule it is associated with (0938-AP52). This approval does not extend to information collection requirements not associated with this rule, for which CMS shall seek separate approval. Should CMS revise the information collection provisions following public comment on the rule, CMS shall submit a revised ICR package as appropriate. CMS also agrees to ensure that the standard PRA blurb and OMB control number and expiration date information appears on each form, prior to fielding the forms. Use of forms without such information is inconsistent with the supporting statement and shall constitute a violation of the PRA. Finally, during the 6 months for which ICR approval has been granted, CMS shall re-evaluate whether the burdens are more appropriately classified as "changes due to agency discretion" rather than "changes due to statute."

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2009	6 Months From Approved	02/28/2009
Responses	38,179,679	0	43,064,549
Time Burden (Hours)	34,671,257	0	40,278,247
Cost Burden (Dollars)	0	0	0

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Abstract: This ICR collects information CMS needs to approve contract applications, determine compliance with the eligibility and associated Medicare Part D participation requirements, make proper payment to plans, and to ensure that correct information is disclosed to enrollees, both potential enrollees and current enrollees.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1860 Name of Statute: null
  

Citations for New Statutory Requirements: Statute at Large: 18 Stat. 1860 Name of Statute: null

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP52	Final or interim final rulemaking	73 FR 67406	11/14/2008

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 28556	05/16/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Prescription Drug Benefit Program (Benes)
Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)
Medicare Prescription Drug Benefit Program (Plan)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	38,179,679	43,064,549	1,000,088	0	-5,884,958	0
Annual Time Burden (Hours)	34,671,257	40,278,247	181,370	0	-5,788,360	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This ICR has been revised to include the new requirements in regulation CMS-4138-IFC2 for agents and brokers of Part D plans to submit information to CMS about their commissions and compensation structures over a multi-year period, to ensure that they are not improperly incentivized to "churn" Medicare beneficiaries from one plan to another without regard for the health impact to the beneficiaries.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/11/2008

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