Medicare Prescription Drug Benefit Program (Plans)

Documents and forms in this information collection

Document Name	Document Type
Form CMS-10141 Compensation Certification Medicare Prescription Drug Benefit Program (Plans)	Form
Form CMS-10141 Description of Compensation Structure Medicare Prescription Drug Benefit Program (Plans)	Form
Form CMS-10141 Covered Agent Information Sheets Workbook Medicare Prescription Drug Benefit Program (Plans)	Form
Form CMS-10141 Compensation Structure for Writing Agents by Contract/PBP Number Medicare Prescription Drug Benefit Program (Plans)	Form
Form CMS-10141 Initial Notice: Notice of Intent to Limit Your Access to Certain Part D Drugs Medicare Prescription Drug Benefit Program (Plans)	Form
Form CMS-10141 Second Notice: Your Access to Certain Part D Drugs is Limited Medicare Prescription Drug Benefit Program (Plans)	Form
Form CMS-10141 Alternate Second Notice Medicare Prescription Drug Benefit Program (Plans)	Form
CMS-10141.Attachments 5a-5c (Instructions).pdf	Instruction
Instructions for Drug Management Program Notices 09242018.docx	Instruction
CMS-10141 Compensation Certification CMS-10141.Attachments 1a-1b (Certifications).pdf	Form
CMS-10141 Description of Compensation Structure CMS-10141.Attachments 2a-2b (Structure Submission Form).pdf	Form
CMS-10141 Covered Agent Information Sheets Workbook CMS-10141.Attachment_3_(Covered_Agent_Information_Sheets_Workbook)2013 P....pdf	Form
CMS-10141 Compensation Structure for Writing Agents by Contract/PB CMS-10141.Attachment_4_(Agent_Compensation_Information_Workbook)-2017 Pa....pdf	Form
CMS-10141 Initial Notice: Notice of Intent to Limit Your Access to Initial Notice 09242018.docx	Form
CMS-10141 Second Notice: Your Access to Certain Part D Drugs is Li 2nd Notice 09242018.docx	Form
CMS-10141 Alternate Second Notice Alternate 2nd Notice 09242018.docx	Form

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