Part D Manufacturer Discount Program

Medicare Part D Manufacturer Discount Program Agreement (CMS-10846)

Documents and Forms

Document Name Document Type
Form CMS-10846 Part D Manufacturer Discount Program Form and Instruction
CMS-10846 HPMS Data Entry Fields Appendix A. Manufacturer Discount Program HPMS Data Entry Fields - CMS-10846.pdf Form and Instruction
CMS-10846 HPMS Data Entry Fields Appendix A. Manufacturer Discount Program HPMS Data Entry Fields - CMS-10846.docx Form and Instruction
CMS-10846 TPA Data Entry Fields Appendix B. Manufacturer Discount Program TPA Data Entry Fields - CMS-10846.pdf Form and Instruction
CMS-10846 TPA Data Entry Fields Appendix B. Manufacturer Discount Program TPA Data Entry Fields - CMS-10846.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Part D Manufacturer Discount Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10846	HPMS Data Entry Fields	Appendix A. Manufacturer Discount Program HPMS Data Entry Fields - CMS-10846.docx		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10846	TPA Data Entry Fields	Appendix B. Manufacturer Discount Program TPA Data Entry Fields - CMS-10846.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 659	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	659	659
Annual IC Time Burden (Hours)	4,613	4,613
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.