Transitional Coverage and Retroactive Medicare Part D Coverage for Certain Low-Income Beneficiaries through the Limited Income Newly Eligible Transition (LI NET) Program (CMS-10831)

ICR 202304-0938-019

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1441 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10831 Beneficiaries Form and Instruction	Modified
CMS-10831_Supporting Statement A (CMS-4201-F version 11).docx Supporting Statement A	2023-04-26

IC Document Collections

IC ID	Document Title	Status
257782	Sponsor (Report to CMS)	Unchanged
257781	Pharmacists (Fax the Documentation to the LI NET Sponsor)	Unchanged
257780	Beneficiaries Form and Instruction	Modified

ICR Details