Information Collection

Collection of Drug Event Data from Contracted Part D Providers For Payments (CMS-10174)

IC 43675 under ICR 202205-0938-017 · OMB 0938-0982.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0982 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PDEGuidance_PRA Disclosure Statement.pdf	Instruction
PDEGuidance_PRA Disclosure Statement.pdf	Instruction
PDE Inbound File Layout.pdf	Instruction
PDE Inbound File Layout.pdf	Instruction

IC Title:

Collection of Drug Event Data from Contracted Part D Providers For Payments (CMS-10174)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

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			PDEGuidance_PRA Disclosure Statement.pdf		Yes	No	Printable Only
Instruction			PDE Inbound File Layout.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 856

Number of Respondents for Small Entity: 149

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,499,966,503	728,413	1,499,238,090
Annual IC Time Burden (Hours)	3,000	2	2,998
Annual IC Cost Burden (Dollars)	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.