OMB
.report
Search
Retiree Drug Subsidy (RDS) Application and Instructions (public, private and union sponsors)
Retiree Drug Subsidy (RDS) Application and Instructions (CMS-10156)
OMB: 0938-0957
IC ID: 8815
OMB.report
HHS/CMS
OMB 0938-0957
ICR 202007-0938-010
IC 8815
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0957 can be found here:
2024-09-23 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10156
Retiree Drug Subsidy (RDS) Application and Instructions (public, private and union sponsors)
Form
CMS10156ApplicationInstructions GDIT edits 2020-04-24.pdf
Instruction
CMS-10156 RDS Application
CMS10156RDSApplication GDIT edits 2020-04-24.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Retiree Drug Subsidy (RDS) Application and Instructions (public, private and union sponsors)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
42 CFR 423 Subpart R
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
CMS10156ApplicationInstructions GDIT edits 2020-04-24.pdf
Yes
No
Printable Only
Form
CMS-10156
RDS Application
CMS10156RDSApplication GDIT edits 2020-04-24.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Medicare Retiree Drug Subsidy Program (RDSP) System No.09-70-0550
FR Citation:
70 FR 41035
Number of Respondents:
1,803
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
1,803
0
0
149
1,654
0
Annual IC Time Burden (Hours)
115,392
0
0
9,536
105,856
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.