Information Collection

Collection of Drug Event Data from Contracted Part D Providers For Payments (CMS-10174)

IC 43675 under ICR 200909-0938-002 · OMB 0938-0982.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0982 can be found here:

Documents and Forms

Document Name Document Type
Attachment B - PDE Record Layout052709.pdf Other-Prescription Drug Event Record
508AttachmentA-PDEGuidance.pdf Instruction
crosswalk.doc crosswalk IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Collection of Drug Event Data from Contracted Part D Providers For Payments (CMS-10174)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			508AttachmentA-PDEGuidance.pdf		Yes	Yes	Paper Only
Other-Prescription Drug Event Record Layout			Attachment B - PDE Record Layout052709.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 747	Number of Respondents for Small Entity: 149

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	947,881,770	-1,470,118,230	2,418,000,000
Annual IC Time Burden (Hours)	1,896	-2,940	4,836
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
crosswalk	crosswalk.doc	08/25/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.