Information Collection

The Medicare Advantage and Prescription Drug Program: Customized Enrollee Data - Initial

IC 195583 under ICR 201012-0938-006 · OMB 0938-1333.

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IC Title:

The Medicare Advantage and Prescription Drug Program: Customized Enrollee Data - Initial

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.111(b)(12) 42 CFR 423.128(b)(11)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 649

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	649	649
Annual IC Time Burden (Hours)	18,620	18,620
Annual IC Cost Burden (Dollars)	0	0

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