Preparation and Issuance of Model Notices (section 423.120(c)(6))

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

OMB: 0938-0964

IC ID: 231341

Documents and Forms
Document Name
Document Type
Other-Part C and D Sample Precluded
Information Collection (IC) Details

View Information Collection (IC)

Preparation and Issuance of Model Notices (section 423.120(c)(6))
 
No Modified
 
Mandatory
 
42 CFR 423.120(c)(6)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Part C and D Sample Precluded Provider Letter Attachment 7 - 2019 Part C and D Sample Precluded Provider Letter (version 2).docx Yes No Fillable Fileable

Health Health Care Services

 

950 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 95,000 0 0 0 0 95,000
Annual IC Time Burden (Hours) 7,885 0 0 0 0 7,885
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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