Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
MDBGpraestimate_COB_5_28.xls	Supplementary Document	Uploaded 2009-05-27	Available
Updated Automated TBT Guidance v2_dis.pdf	Supplementary Document	Uploaded 2009-05-21	Available
crosswalkCOB.doc	Supplementary Document	Uploaded 2009-05-27	Source copy available
Instructions SPAP_dis.pdf	Supplementary Document	Uploaded 2009-05-21	Available
Final Automated TBT Guidance_dis.pdf	Supplementary Document	Uploaded 2009-05-21	Available
CMS-10171 Supporting Statement_CLN_12-9-09.docx	Supporting Statement A	Uploaded 2009-12-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8840	Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers (CMS-10171)	Instruction	Modified

ICR Details

OMB Control No: 0938-0978	ICR Reference No: 200906-0938-015
Status: Historical Active	Previous ICR Reference No: 200604-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/23/2009
	Date Received in OIRA: 06/25/2009
Terms of Clearance: This ICR is approved for one year only, as inaccurate burden estimates were published in the 60 and 30 day Federal Register notices. CMS agrees to promptly republish the 60 day FRN with the correct burden estimates and a clear explanation for why CMS estimates that the burden reduction is so dramatic. Upon resubmission of this package to OMB, CMS shall (1) make sure that the burden estimates provided in supporting materials (the supporting statement and Excel spreadsheet) match what is reported in the ICRAS/ROCIS systems, (2) make sure that the capital costs are correctly accounted for,(3) ensure that any burden reductions due to prior overestimates are classified as "changes due to adjustment in agency estimate", and (4) ensure that the data field regarding percentage of responses submitted electronically is revised, as appropriate. Future submissions that do not meet these requirements will be returned to CMS as "improperly submitted." CMS is also reminded that an ICR must be submitted and approved PRIOR to the information collections going into effect. In this case, the supporting materials indicate that the burden changes result from a policy change issued through a 10/20/2008 HPMS Memo called "Automated Troop Balance Transfer Process". This ICR should have been submitted prior to the issuance of that Memo. Future submissions that are received after information collection requirements have gone into effect will be considered PRA violations.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	36 Months From Approved	12/31/2009
Responses	2,153,767,270	0	2,153,767,270
Time Burden (Hours)	1,017,914	0	1,017,914
Cost Burden (Dollars)	0	0	0

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Abstract: This information is necessary to assist with coordination of prescription drug benefits provided to the Medicare beneficary at the pharmacy.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 101 Name of Law: Part D- Voluntary Prescription Drug Benefit Program
  

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 4194	01/25/2005

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 8964	02/27/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 22933	05/15/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers (CMS-10171)

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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	2,153,767,270	2,153,767,270	0	0	0	0
Annual Time Burden (Hours)	1,017,914	1,017,914	0	0	0	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: Burden changes reflect the change in number of respondents (sponsors, states, pharmacies), new estimates based upon experience of the respondents, and the new Automatic TrOOP Balance Transfer process.

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Annual Cost to Federal Government: $9,000,000

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: 06/25/2009

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