Business Continuity Plans under 422.504(o) and 423.505(p)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0964 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10141 Business Continuity Plans under 422.504(o) and 423.505(p) Form
CMS-10141.Attachment 5 (Instructions) (version2).pdf Instruction
CMS-10141 Compensation Certifications CMS-10141.Attachment 1 (Certifications) (version 2).pdf Form
CMS-10141 Structure Submission Forms CMS-10141.Attachment 2 (Structure Submission Form) (version 2).pdf Form
CMS-10141 Covered Agent Information Sheet CMS-10141.Attachment_3_(Covered_Agent_Information_Sheets_Workbook) (version 2).pdf Form
CMS-10141 Compensation Structure for Writing Agents by Contract/PB CMS-10141.Attachment_4_(Agent_Compensation_Information_Workbook) (version2).pdf Form

Information Collection (IC) Details

IC Title:	Business Continuity Plans under 422.504(o) and 423.505(p)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.505(p) 42 CFR 422.504(o)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10141	Compensation Certifications	CMS-10141.Attachment 1 (Certifications) (version 2).pdf	Yes	Yes	Fillable Fileable
Form	CMS-10141	Structure Submission Forms	CMS-10141.Attachment 2 (Structure Submission Form) (version 2).pdf	Yes	Yes	Fillable Fileable
Form	CMS-10141	Covered Agent Information Sheet	CMS-10141.Attachment_3_(Covered_Agent_Information_Sheets_Workbook) (version 2).pdf	Yes	Yes	Fillable Fileable
Form	CMS-10141	Compensation Structure for Writing Agents by Contract/PBP Number	CMS-10141.Attachment_4_(Agent_Compensation_Information_Workbook) (version2).pdf	Yes	Yes	Fillable Fileable
Instruction			CMS-10141.Attachment 5 (Instructions) (version2).pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 99	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	99	99
Annual IC Time Burden (Hours)	15,920	15,920
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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