Retiree Drug Subsidy (RDS) Payment Request and Instructions (public, private and union sponsors)

Retiree Drug Subsidy Payment Request Instructions (CMS-10170)

OMB: 0938-0977

IC ID: 8838

Documents and Forms

Document Name Document Type
CMS10170 Application Instructions 9_19.docx Instruction
CMS-10170 Retiree Drug Subsidy Payment CMS10170 RDS Application.docx Form
CMS10170ApplicationInstructions GDIT edits 2024-05-24.docx CMS-10170_RDS Instructions_Track Change IC Document
CMS10170RDSApplication GDIT edits 2024-05-24.docx CMS_10170_RDS Application Track Change IC Document