Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)

Medicare Prescription Drug Benefit Program

OMB: 0938-0964

IC ID: 187164

Information Collection (IC) Details

View Information Collection (IC)

Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)
 
No Modified
 
Mandatory
 
42 CFR 423

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Compensation Certification CMS-10141.Attachments 1a-1b (Certifications)-11-07-08.doc Yes Yes Paper Only
Instruction CMS-10141.Attachments 5a-5c (Instructions)-11-07-08.doc Yes Yes Paper Only
Other-Compensation Structure Submission Form CMS-10141.Attachments 2a-2b (Structure Submission Form)-11-07-08.doc Yes Yes Paper Only

Health Health Care Services

 

1,018,762 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,163,672 0 0 -26,828 0 2,190,500
Annual IC Time Burden (Hours) 1,027,952 0 0 63,682 0 964,270
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10141 CMS-10141.Attachment 3 (Covered Agent Information Sheets Workbook)-11-07-08.xls 05/06/2009
CMS-10141 CMS-10141.Attachment 4 (Agent Compensation Information Workbook)-11-07-08.xls 05/06/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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