CMS-10141 Compensation Structure for Writing Agents by Contract/PB

Medicare Prescription Drug Benefit Program

CMS-10141.Attachment_4_(Agent_Compensation_Information_Workbook)-2013 Part D PRA.xls

Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)

OMB: 0938-0964

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Overview

2006 Marketing Organizations
2006 Writing Agents (Plan Paid)
2006 Writing Agents (M.O. Paid)
2007 Marketing Organizations
2007 Writing Agents (Plan Paid)
2007 Writing Agents (M.O. Paid)
2008 Marketing Organizations
2008 Writing Agents (Plan Paid)
2008 Writing Agents (M.O. Paid)
2009 Marketing Orgs
2009 Writing Agents (Plan Paid)
2009 Writing Agents (M.O. Paid)
PRA Disclosure Statement


Sheet 1: 2006 Marketing Organizations

2006 Compensation Information on Marketing Organizations by Contract/PBP Number
(To be completed by organizations that pay contracted marketing organizations.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 2: 2006 Writing Agents (Plan Paid)

2006 Compensation Information on Writing Agents by Contract/PBP Number
(To be completed by organizations that pay writing agents directly.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 3: 2006 Writing Agents (M.O. Paid)

2006 Compensation Information on Writing Agents by Contract/PBP Number
(To be completed by organizations for writing agents paid by marketing organizations with which they contract.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 4: 2007 Marketing Organizations

2007 Compensation Information on Writing Agents by Contract/PBP Number
(To be completed by organizations that pay contracted marketing organizations.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 5: 2007 Writing Agents (Plan Paid)

2007 Compensation Information on Writing Agents by Contract/PBP Number
(To be completed by organizations that pay writing agents directly.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 6: 2007 Writing Agents (M.O. Paid)

2007 Compensation Information on Writing Agents by Contract/PBP Number
(To be completed by organizations for writing agents paid by marketing organizations with which they contract.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 7: 2008 Marketing Organizations

2008 Compensation Information on Writing Agents by Contract/PBP Number
(To be completed by organizations that pay contracted marketing organizations.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 8: 2008 Writing Agents (Plan Paid)

2008 Compensation Information on Writing Agents by Contract/PBP Number
(To be completed by organizations that pay writing agents directly.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 9: 2008 Writing Agents (M.O. Paid)

2008 Compensation Information on Writing Agents by Contract/PBP Number
(To be completed by organizations for writing agents paid by marketing organizations with which they contract.)


Initial Compensation Life Cycle Compensation
Contract/PBP Number Number of Beneficiaries Min Max Mean Median Min Max Mean Median









































Sheet 10: 2009 Marketing Orgs

2009 Compensation Structure for Marketing Organizations by Contract/PBP Number
(To be completed by organizations that pay contracted marketing organizations.)
Contract/PBP Number Structure Number Initial Comp Renewal Years (as applicable) # of Agents
1 2 3 4 5 6 7 8 9 10

























































Sheet 11: 2009 Writing Agents (Plan Paid)

2009 Compensation Structure for Writing Agents by Contract/PBP Number
(To be completed by organizations that pay writing agents directly.)
Contract/PBP Number Calculated Based on Option One or Option Two (Enter 1 or 2 below) Structure Number 6-Year Compensation Cycle Number of Agents
Initial Comp Renewal Years
1 2 3 4 5









































Sheet 12: 2009 Writing Agents (M.O. Paid)

2009 Compensation Structure for Writing Agents by Contract/PBP Number
(To be completed by organizations for writing agents paid by marketing organizations with which they contract.)
Contract/PBP Number Calculated Based on Option One or Option Two (Enter 1 or 2 below) Structure Number 6-Year Compensation Cycle Number of Agents
Initial Comp Renewal Years
1 2 3 4 5






























Not Applicable









Sheet 13: PRA Disclosure Statement

PRA Disclosure Statement


According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0964. The time required to complete this information collection is estimated to average 49 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
File Typeapplication/vnd.ms-excel
AuthorChevell L. Thomas
Last Modified ByDeborah Larwood
File Modified2013-09-13
File Created2008-10-30

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