Information Collection Request
ICR 201009-0938-015 · OMB 0938-1113 · Public filing
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1113 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10316 Medicare Prescriptio Medicare Advantage Prescription Drug Plan (MA-PD) Disenrollment Reasons Survey (CMS-10316) |
Form and Instruction | New | Available |
| Form CMS-10316 Medicare Prescription Drug Plan (PDP) Disenrollment Reasons Survey - (CMS-10316) |
Form and Instruction | New | Available |
 SUPPORTING STATEMENT B.pdf |
Supporting Statement B | Uploaded 2010-09-22 | Available |
| Response_to_Public_Comments_09_02_10.pdf |
Supplementary Document | Uploaded 2010-09-22 | Available |
 Supporting Statement TOC.doc |
Supplementary Document | Uploaded 2010-09-22 | Available |
| Medicare Disenrollee Stand Alone PDP Crosswalk w response options.pdf |
Supplementary Document | Uploaded 2010-09-22 | Available |
| Medicare Disenrollee MA Crosswalk w response options.pdf |
Supplementary Document | Uploaded 2010-09-22 | Available |
| SUPPORTING STATEMENT A.doc |
Supporting Statement A | Uploaded 2010-09-22 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 194738 |  Medicare Prescriptio Medicare Advantage Prescription Drug Plan (MA-PD) Disenrollment Reasons Survey (CMS-10316) |
Form and Instruction | New | |
| 194737 | Medicare Prescription Drug Plan (PDP) Disenrollment Reasons Survey - (CMS-10316) |
Form and Instruction | New |
ICR Details
| OMB Control No | 0938-1113 |
|---|