Creditable Coverage Disclosure to CMS OnLine Form and Instructions

ICR 201312-0938-006

OMB: 0938-1013

Federal Form Document

ICR Details
0938-1013 201312-0938-006
Historical Active 200911-0938-003
HHS/CMS 20998
Creditable Coverage Disclosure to CMS OnLine Form and Instructions
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 02/12/2014
Retrieve Notice of Action (NOA) 12/06/2013
  Inventory as of this Action Requested Previously Approved
02/28/2017 36 Months From Approved
86,744 0 0
7,364 0 0
0 0 0

Information collection requirements will ensure that entities that currently provide prescription drug benefits to any Medicare Part D eligible individual disclose to CMS whether the prescription drug benefit that they offer is creditable coverage. The disclosure is required to be provide annually and upon any change that affects whether the coverage is creditable prescription drug coverage. This collection also provides creditable coverage disclosure instructions for entities complying with these infromation collection request.

Statute at Large: 1 Stat. 1860 Name of Statute: null
  
None

Not associated with rulemaking

  78 FR 38986 06/28/2013
78 FR 70057 11/22/2013
Yes

  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 86,744 0 0 0 -756 87,500
Annual Time Burden (Hours) 7,364 0 0 0 72 7,292
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The previous PRA package estimated the number of responses to be 87,500 annually. CMS has adjusted the annual estimated number of responses based on actual contractor data. The annual revised number is 87,265. The change to the annual burden is a mathematical calculation and the result of a decrease in the number of plan who offer private prescription drug coverage to Medicare-eligible individuals. There are no program changes. Revisions to the Instructions and Screen Shots are set out in the Crosswalk and have no impact on prev burden estimates. Revisions are mostly for clarification, to remove redundancy, etc.

$112,000
No
No
No
No
No
Uncollected
Mitch Bryman 410 786-5258 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/06/2013


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