Medicare Prescription Drug Benefit Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10141 Compensation Structure for Writing Agents by Contract/PBP Number	Form	Unchanged	Available
Form CMS-10141 Writing Agents Information Sheet	Form	Unchanged	Repair queued
CMS-10141 - Supporting Statement A - Passback4 dl CLEAN.docx	Supporting Statement A	Uploaded 2015-10-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8823	Medicare Prescription Drug Benefit Program (Benes)		Unchanged
217122	Business Continuity Plans under 422.504(o) and 423.505(p)		New
209891	State Eligibility Determinations [423.904(b)] and Reporting [423.910(d)]		Modified
187164	Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)	Form	Unchanged	Compensation Structure for Writing Agents by Contract/PBP Number
187164	Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)	Form	Unchanged	Writing Agents Information Sheet
187164	Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)	Other-Compensation Certification	Unchanged

ICR Details

OMB Control No: 0938-0964	ICR Reference No: 201506-0938-007
Status: Historical Active	Previous ICR Reference No: 201312-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Prescription Drug Benefit Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/29/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/19/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2018	36 Months From Approved	02/28/2017
Responses	46,099,944	0	46,099,845
Time Burden (Hours)	7,588,143	0	7,572,223
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
   PL: Pub.L. 108 - 173 101 Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
  

Citations for New Statutory Requirements: PL: Pub.L. 108 - 173 101 Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 19323	04/10/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 35362	06/19/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Business Continuity Plans under 422.504(o) and 423.505(p)
Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)	CMS-10141, CMS-10141	Writing Agents Information Sheet ,   Compensation Structure for Writing Agents by Contract/PBP Number
Medicare Prescription Drug Benefit Program (Benes)
State Eligibility Determinations [423.904(b)] and Reporting [423.910(d)]

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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	46,099,944	46,099,845	99	0	0	0
Annual Time Burden (Hours)	7,588,143	7,572,223	15,920	0	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: No

Burden Reduction Due to:

Short Statement: This is a revision of an approved collection. We are adding a new burden to reflect business continuity requirements finalized in §§ 422.504(o) and 423.505(p). The revision will add 15,920 hours.

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Annual Cost to Federal Government: $698

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: 06/19/2015

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