State Eligibility Determinations (423.904(b)) and Reporting (423.910(d))

Medicare Prescription Drug Benefit Program (CMS-10141)

OMB: 0938-0964

IC ID: 209891

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State Eligibility Determinations (423.904(b)) and Reporting (423.910(d))
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
42 CFR 423

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

51 0
   
State, Local, and Tribal Governments
 
   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 600,102 0 0 0 0 600,102
Annual IC Time Burden (Hours) 13,260 0 0 0 0 13,260
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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