Information Collection Request
Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey (CMS-10316)
ICR 202304-0938-020 · OMB 0938-1113 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1113 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10316 Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only) |
Form | Modified | Repair queued |
| Form CMS-10316 Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version |
Form | Modified | Repair queued |
 supporting statement A_disenrollment reasons survey_.docx |
Supporting Statement A | Uploaded 2023-04-28 | Repair queued |
| CMS-10316_supporting statement B_disenrollment reasons survey_.docx |
Supporting Statement B | Uploaded 2023-04-26 | Repair queued |
 PDP Disenrollment Survey crosswalk_OMB__1.25.2023_508Compliant.pdf |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| MA-Only Disenrollment Survey crosswalk_OMB_1.25.2023_508Compliant.pdf |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| MA_PD Disenrollment Survey crosswalk_OMB__1.25.2023_508Compliant.pdf |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 207675 |  Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only) |
Form | Modified | |
| 194737 | Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1113 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202003-0938-016 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |