Information Collection

Beneficiary-Level Program Data Submission:

IC 266610 under ICR 202404-0938-007 · OMB 0938-1468.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10887 Beneficiary-Level Program Data Submission:	Form and Instruction
CMS-10887 Medicare Prescription Payment Plan example data layout PRA_MARx_OMB 0938_Appendix A_04022024.pdf	Form and Instruction
CMS-10887 Medicare Prescription Payment Plan example data layout PRA_MARx_OMB 0938_Appendix A_04022024.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.514

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10887	Medicare Prescription Payment Plan example data layout	PRA_MARx_OMB 0938_Appendix A_04022024.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Medicare Advantage Prescription Drug (MARx) System

FR Citation: 70 FR 60530

Number of Respondents: 856

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 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	3,200,000	3,200,000
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.