Medicare Prescription Drug Coverage and Your Rights (CMS-10147)

ICR 202103-0938-014

OMB: 0938-0975

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2021-03-25
IC Document Collections
IC ID
Document
Title
Status
37927 Modified
ICR Details
0938-0975 202103-0938-014
Received in OIRA 201804-0938-011
HHS/CMS CM-CPC
Medicare Prescription Drug Coverage and Your Rights (CMS-10147)
Reinstatement without change of a previously approved collection   No
Regular 03/26/2021
  Requested Previously Approved
36 Months From Approved
49,681,292 0
827,690 0
0 0

Pursuant to 42 CFR 423.562(a)(3) and 423.128(b)(7)(iii), Part D plan sponsors must arrange with their network pharmacies to provide a printed copy of the standardized pharmacy notice to enrollees (beneficiaries) at the point of sale when an enrollee's prescription cannot be filled.

Statute at Large: 18 Stat. 1860
   Statute at Large: 18 Stat. 1852
  
None

Not associated with rulemaking

  86 FR 3159 01/14/2021
86 FR 15943 03/25/2021
No

1
IC Title Form No. Form Name
Standardized Pharmacy Notice CMS-10147 Notice: Medicare Prescription Drug Coverage and Your Rights

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 49,681,292 0 0 0 9,581,292 40,100,000
Annual Time Burden (Hours) 827,690 0 0 0 159,624 668,066
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The 159,624 hour increase in burden is an adjustment that is based on the increased number of applicable pharmacies (+8,000 pharmacies) and the increased number of standardized pharmacy notices (+9,581,292 notices) that are likely to be distributed based on using more accurate CY 2018 Public Use File and prescription drug event data.

$0
No
    No
    No
No
No
No
No
Stephan McKenzie 410 786-1943 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/26/2021


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