Information Collection

Medicare Part D Reporting Requirements

IC 8853 under ICR 201508-0938-012 · OMB 0938-0992.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0992 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10185 Medicare Part D Reporting Requirements	Form and Instruction
CMS-10185 Medicare Part D Reporting Requirements CY2016_Part D Reporting Requirements [rev 05-17-2016 by OSORA PRA].pdf	Form and Instruction
CY2015 to CY2016 Crosswalk_final [11-18-2015].xlsx Crosswalk	IC Document

IC Title:

Medicare Part D Reporting Requirements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.505 42 CFR 423.514

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10185	Medicare Part D Reporting Requirements	CY2016_Part D Reporting Requirements [rev 05-17-2016 by OSORA PRA].pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 694

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,487	-2,580	8,067
Annual IC Time Burden (Hours)	8,783	-3,875	12,658
Annual IC Cost Burden (Dollars)	392,780	-184,686	577,466

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	CY2015 to CY2016 Crosswalk_final [11-18-2015].xlsx	11/18/2015

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