Medicare Prescription Drug Benefit Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
REVISION TO CMS 10141.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-03-08	Available
CMS-10141.Attachment 3 (Covered Agent Information Sheets Workbook)-11-07-08.xls	Supplementary Document	Uploaded 2009-05-06	Available
CMS-10141.Attachment 4 (Agent Compensation Information Workbook)-11-07-08.xls	Supplementary Document	Uploaded 2009-05-06	Available
CMS-10141 Supporting Statement Part A (Corrected then revised)_CLEAN.DOCX	Supporting Statement A	Uploaded 2012-03-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8823	Medicare Prescription Drug Benefit Program (Benes)		Modified
187164	Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)	Other-Compensation Certification	Modified

ICR Details

OMB Control No: 0938-0964	ICR Reference No: 201203-0938-004
Status: Historical Active	Previous ICR Reference No: 201008-0938-020
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Prescription Drug Benefit Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/20/2012
	Date Received in OIRA: 03/13/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	01/31/2014	01/31/2014
Responses	41,278,271	0	43,153,271
Time Burden (Hours)	35,582,601	0	36,520,101
Cost Burden (Dollars)	0	0	0

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Abstract: The voluntary prescription drug benefit program was enacted into law on December 8, 2003 in section 101 of Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The MMA specifies that the prescription drug benefit program will be available to beneficiaries on January 1, 2006. Coverage for the prescription drug benefit will be provided under private prescription drug plans, or through Medicare Advantage prescription drug plans. Organizations offering drug plans will have flexibility in the design of the prescription drug benefit.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1860 Name of Statute: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP77	Final or interim final rulemaking	75 FR 19678	04/15/2010

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Prescription Drug Benefit Program (Benes)
Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)

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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	41,278,271	43,153,271	0	-1,875,000	0	0
Annual Time Burden (Hours)	35,582,601	36,520,101	0	-937,500	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: Yes

Burden Reduction Due to: Cutting Redundancy

Short Statement: The burden associated with the requirements in 42 CFR 423.153(d)(1)(vii) have been removed from this package. Specifically, the overall burden associated with this information collection request (0938-0964) has been reduced by 1,875,000 respondents and 937,000 burden hours because CMS created a new standardized format for comprehensive medication review (CMR) action plan and summary. The new standardized format for the CMR action plans and summaries is now approved under OCN 0938-1154.

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Annual Cost to Federal Government: $200,000

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: 03/12/2012

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