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

Collection of Prescription Drug Data from MA-PD, PDP and Fallout Plans/Sponsors for Medicare Part D Payments (CMS-10174)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.