Information Collection

Medicare Part D Reporting Requirements

IC 8853 under ICR 202005-0938-013 · OMB 0938-0992.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0992 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CY2021_Part D Reporting Requirements_070120.pdf	Instruction

IC Title:

Medicare Part D Reporting Requirements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.514 42 CFR 423.505

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CY2021_Part D Reporting Requirements_070120.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 744

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	17,080	0	3,477	13,603
Annual IC Time Burden (Hours)	25,256	6,473	1,418	17,365
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
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.