Information Collection

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

IC 43675 under ICR 201309-0938-034 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
PDEGuidance.pdf	Instruction
PDE Inbound File Layout Effective February 28-2013.xls	Instruction
Crosswalk.doc Crosswalk	IC Document

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			PDEGuidance.pdf		Yes	No	Printable Only
Instruction			PDE Inbound File Layout Effective February 28-2013.xls		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 767

Number of Respondents for Small Entity: 149

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,161,434,065	213,552,295	947,881,770
Annual IC Time Burden (Hours)	2,323	427	1,896
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	Crosswalk.doc	09/11/2013

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