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CMS-10141 Exhibit C: Example of Section 2 (Drug Payment Stages)
Comprehensive Addiction and Recovery Act of 2016 (CARA) / Medicare Prescription Drug Benefit Program (CMS-10141)
Attachment 8d - CY 2020 EOB Exhibit C (version 2)
Medicare Prescription Drug Benefit Program (Plans)
OMB: 0938-0964
OMB.report
HHS/CMS
OMB 0938-0964
ICR 201906-0938-001
IC 187164
CMS-10141 Exhibit C: Example of Section 2 (Drug Payment Stages)
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⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0964 can be found here:
2023-02-22 - Revision of a currently approved collection
2022-04-27 - Revision of a currently approved collection
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