Standardized Pharmacy Notice

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

OMB: 0938-0975

IC ID: 37927

Information Collection (IC) Details

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Standardized Pharmacy Notice
 
No Modified
 
Mandatory
 
42 CFR 423.562(a)(3) 42 CFR 128(b)(7)(iii)  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10147 Notice: Medicare Prescription Drug Coverage and Your Rights Pharmacy Notice_CMS 10147_508ed 05 02 2018.pdf No   Fillable Printable
Instruction Instructions_CMS 10147_02272017_CLEAN.PDF No   Printable Only

Health Health Care Services

 

70,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 49,681,292 0 0 9,581,292 40,100,000 0
Annual IC Time Burden (Hours) 827,690 0 0 159,624 668,066 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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