Information Collection Request
Pharmacy Benefit Manager Transparency (CMS-10725)
ICR 202404-0938-029 · OMB 0938-1394 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10725 PBM - Annual Submission of Prescription Benefit Information |
Form and Instruction | Modified | Missing upstream |
 CMS-10725 - Supporting_Statement A_rev.docx |
Supporting Statement A | Uploaded 2024-04-30 | Missing upstream |
| CMS-10725_PBM Transparency_Supporting Statement B_04.12.24.docx |
Supporting Statement B | Uploaded 2024-04-30 | Missing upstream |
 Section 1150A - PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS.pdf |
Supplementary Document | Uploaded 2021-04-20 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 243638 |  Identification of QHPs |
Modified | ||
| 243637 | PBM - Annual Submission of Prescription Benefit Information |
Form and Instruction | Modified | |
| 243636 | One-Time Technical Build |
Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1394 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202009-0938-009 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |