Information Collection Request

Data Request and Attestation for PDP Sponsors (CMS-10691)

ICR 202209-0938-006 · OMB 0938-1371 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10691 Data Request and Attestation for PDP Sponsors Form and Instruction Modified Repair queued
Change crosswalk 6-16.pdf Supplementary Document Uploaded 2022-09-28 Repair queued
CMS-10691 - Supporting Statement A.docx Supporting Statement A Uploaded 2022-09-30 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
236066 Data Request and Attestation for PDP Sponsors Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 11/30/2022
200 73
37 1
0 0





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1
table that charts list of burden
IC Title Form No. Form Name
Data Request and Attestation for PDP Sponsors CMS-10691 Medicare A & B Claims Data to Part D Plan Sponsors API (AB2D) API Screens

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 200 73 0 127 0 0
Annual Time Burden (Hours) 37 1 0 36 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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  No