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
crosswalkPRA4_23_10.doc	Supplementary Document	Uploaded 2010-08-05	Available
MDBGpraestimate_COB_2-2010.xls	Supplementary Document	Uploaded 2010-08-05	Available
Updated Automated TBT Guidance v2_dis.pdf	Supplementary Document	Uploaded 2010-08-05	Available
Instructions SPAP_dis.pdf	Supplementary Document	Uploaded 2010-08-05	Available
CMS-10171 Supporting Statement4-23-2010clean.docx	Supporting Statement A	Uploaded 2010-08-05	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: 201008-0938-009
Status: Historical Active	Previous ICR Reference No: 200906-0938-015
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 without change	Conclusion Date: 11/23/2010
	Date Received in OIRA: 08/17/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2013	36 Months From Approved	12/31/2010
Responses	248,018	0	2,153,767,270
Time Burden (Hours)	754,788	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:
	75 FR 27787	05/18/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 44969	07/30/2010
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	248,018	2,153,767,270	0	55,856	-2,153,575,108	0
Annual Time Burden (Hours)	754,788	1,017,914	0	12,858	-275,984	0
Annual Cost Burden (Dollars)	0	0	0	0	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: Large reductions in the estimate are due to the following: Fewer new organizations (hence fewer respondents) entering into Part D contracts than at the beginning of the program. CMS increased knowledge and the time necessary to program process N transactions. The original estimate was grossly overstated. Remove of an estimate associated with voluntary data sharing agreements and submission of COB files to COB contractor. These estimates are captured under MSP PRA 0938-0214.

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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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 08/17/2010

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