Information Collection Request
Medicare Prescription Drug Benefit Program - IRASA (CMS-10141)
ICR 202302-0938-009 · OMB 0938-0964 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0964 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10141 Preparation and Issuance of Model Notices (section 423.120(c)(6)) |
Form and Instruction | Modified | Repair queued |
 CMS-10141 - Supporting Statement A_IRASA reporting_.docx |
Supporting Statement A | Uploaded 2023-02-17 | Repair queued |
 2023 Crosswalk for PRA 10141.pdf |
Supplementary Document | Uploaded 2023-02-15 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8823 |  Medicare Prescription Drug Benefit Program (Benes) |
Modified | ||
| 231341 | Preparation and Issuance of Model Notices (section 423.120(c)(6)) |
Form and Instruction | Modified | |
| 217122 | Business Continuity Plans under 422.504(o) and 423.505(p) |
Modified | ||
| 209891 | State Eligibility Determinations (423.904(b)) and Reporting (423.910(d)) |
Modified | ||
| 187164 | Medicare Prescription Drug Benefit Program (Plans) |
Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0964 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202204-0938-002 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |