OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 187164 under ICR 201506-0938-007 · OMB 0938-0964.

Documents and Forms
Document Name
Document Type
Other-Compensation Certification
Instruction
Other-Compensation Structure Submiss
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Medicare Prescription Drug Benefit Program (PLAN)-(CMS-10141)
 
No Unchanged
 
Mandatory
 
42 CFR 423

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Compensation Certification CMS-10141.Attachments 1a-1b (Certifications)-11-07-08.doc Yes Yes Paper Only
Instruction CMS-10141.Attachments 5a-5c (Instructions)-11-07-08.doc Yes Yes Paper Only
Other-Compensation Structure Submission Form CMS-10141.Attachments 2a-2b (Structure Submission Form)-11-07-08.doc Yes Yes Paper Only
Form CMS-10141 Writing Agents Information Sheet CMS-10141.Attachment_3_(Covered_Agent_Information_Sheets_Workbook)2013 Part D.xls Yes Yes Fillable Printable
Form CMS-10141 Compensation Structure for Writing Agents by Contract/PBP Number CMS-10141.Attachment_4_(Agent_Compensation_Information_Workbook)-2013 Part D PRA.xls Yes Yes Fillable Printable

Health Health Care Services

 

86,378 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 35,484,743 0 0 0 0 35,484,743
Annual IC Time Burden (Hours) 4,661,013 0 0 0 0 4,661,013
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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