Retiree Drug Subsidy Payment Request Instructions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10170 Additiional Information.doc	Supplementary Document	Uploaded 2009-03-03	Repair queued
CMS-10170 Crosswalk of Changes.doc	Supplementary Document	Uploaded 2009-03-03	Available
CMS10170RDSPaymentSupportingStatement.pdf	Supporting Statement A	Uploaded 2009-03-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8838	Retiree Drug Subsidy (RDS) Payment Request and Instructions (CMS-10170)	Other-Payment Set-Up (CMS-10170)	Modified
188650	Retiree Drug Subsidy (RDS) Payment Request and Instructions (CMS-10170)	Other-TRK Changes	New

ICR Details

OMB Control No: 0938-0977	ICR Reference No: 200904-0938-001
Status: Historical Active	Previous ICR Reference No: 200603-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Retiree Drug Subsidy Payment Request Instructions
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: 09/15/2009
	Date Received in OIRA: 04/02/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	36 Months From Approved	09/30/2009
Responses	4,500	0	6,000
Time Burden (Hours)	679,500	0	222,000
Cost Burden (Dollars)	0	0	68,136,000

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Abstract: Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and implementing regulations at 42 CFR ?423 Subpart R, Plan Sponsors (e.g., employers or unions) that offer prescription drug coverage to their qualifying covered retirees are eligible to receive a 28% tax-free subsidy for allowable drug costs. In order to receive the subsidy, a Plan Sponsor must submit required prescription drug cost data and certain other data to CMS.

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Authorizing Statute(s): US Code: 42 USC 1395 W-132 Name of Law: Special Rules for employer sponsored programs
   Statute at Large: 18 Stat. 1860 Name of Statute: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AN08	Final or interim final rulemaking	70 FR 4191	01/28/2005

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 72486	11/28/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 7233	02/13/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Retiree Drug Subsidy (RDS) Payment Request and Instructions (CMS-10170)
Retiree Drug Subsidy (RDS) Payment Request and Instructions (CMS-10170)

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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	4,500	6,000	0	-1,500	0	0
Annual Time Burden (Hours)	679,500	222,000	0	457,500	0	0
Annual Cost Burden (Dollars)	0	68,136,000	0	-68,136,000	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: For each entity, we estimate an increased burden, primarily attributable to the fact that the burden estimate now includes an estimate of the time it takes to submit the reconciliation or final payment request by following the 12-step reconciliation process. That process had not been developed at the time the 2005 PRA package was submitted. For details, see the Supporting Statement.

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Annual Cost to Federal Government: $20,600,000

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)? No

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: 04/02/2009

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