Medicare Prescription Drug Benefit Program (Plans)

Comprehensive Addiction and Recovery Act of 2016 (CARA) / Medicare Prescription Drug Benefit Program (CMS-10141)

OMB: 0938-0964

IC ID: 187164

Information Collection (IC) Details

View Information Collection (IC)

Medicare Prescription Drug Benefit Program (Plans)
 
No Modified
 
Mandatory
 
42 CFR 423

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10141 Second Notice: Your Access to Certain Part D Drugs is Limited 2nd Notice 09242018.docx Yes Yes Fillable Fileable
Form CMS-10141 Alternate Second Notice Alternate 2nd Notice 09242018.docx Yes Yes Fillable Fileable
Instruction Instructions for Drug Management Program Notices 09242018.docx Yes Yes Printable Only
Form CMS-10141 Initial Notice: Notice of Intent to Limit Your Access to Certain Part D Drugs Initial Notice 09242018.docx Yes Yes Fillable Fileable
Form CMS-10141 Compensation Certification CMS-10141.Attachments 1a-1b (Certifications).pdf Yes Yes Fillable Fileable
Instruction CMS-10141.Attachments 5a-5c (Instructions).pdf Yes Yes Paper Only
Form CMS-10141 Description of Compensation Structure CMS-10141.Attachments 2a-2b (Structure Submission Form).pdf Yes Yes Fillable Fileable
Form CMS-10141 Covered Agent Information Sheets Workbook CMS-10141.Attachment_3_(Covered_Agent_Information_Sheets_Workbook)2013 P....pdf Yes Yes Fillable Printable
Form CMS-10141 Compensation Structure for Writing Agents by Contract/PBP Number CMS-10141.Attachment_4_(Agent_Compensation_Information_Workbook)-2017 Pa....pdf Yes Yes Fillable Printable

Health Health Care Services

 

757 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 43,862,376 0 0 8,377,633 0 35,484,743
Annual IC Time Burden (Hours) 5,687,919 0 0 1,026,906 0 4,661,013
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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