Application for Enrollment in
Part B Immunosuppressive Drug Coverage (Part B-ID) (CMS-10798)
New
collection (Request for a new OMB Control Number)
No
Regular
07/05/2022
Requested
Previously Approved
36 Months From Approved
767
0
128
0
0
0
The CMS-10798 provides the necessary
information to determine eligibility and to process the
beneficiary’s request for enrollment for in Part B-ID coverage.
This form is only used for enrollment by beneficiaries whose
Medicare entitlement based on ESRD would otherwise end after a
successful kidney transplant to continue enrollment under Medicare
Part B only for the coverage of immunosuppressive drugs who already
have Part A, but not Part B.
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.