Information Collection

Hospice Information for Medicare Part D Plans

IC 214736 under ICR 201501-0938-006 · OMB 0938-1269.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1269 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10538 Hospice Information for Medicare Part D Plans Form and Instruction
CMS-10538 Hospice Information for Medicare Part D Plans Form [rev 01-23-2015 by OSORA PRA].docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hospice Information for Medicare Part D Plans	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10538	Hospice Information for Medicare Part D Plans	Form [rev 01-23-2015 by OSORA PRA].docx		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 424	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	376,487	376,487
Annual IC Time Burden (Hours)	31,374	31,374
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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