Public - Retiree Drug Subsidy (RDS) Application and Instructions

Retiree Drug Subsidy (RDS) Application and Instructions (CMS-10156)

OMB: 0938-0957

IC ID: 187541

Information Collection (IC) Details

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Public - Retiree Drug Subsidy (RDS) Application and Instructions
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 423 Subpart R

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-10156 Application Instructions (rev 02-22-2017 by OSORA PRA).pdf Yes No Printable Only
Form CMS-10156 RDS Application CMS-10156 - Application (rev 02-22-2017 by OSORA PRA).pdf Yes Yes Fillable Printable

Health Health Care Services

Medicare Retiree Drug Subsidy Program (RDSP) System No.09-70-0550  70 FR 41035

828 0
   
State, Local, and Tribal Governments
 
   100 %

  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 828 0 -672 0 0 1,500
Annual IC Time Burden (Hours) 52,992 0 -43,008 0 0 96,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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