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

IC 8815 under ICR 202409-0938-026 · OMB 0938-0957.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Form
Form
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Retiree Drug Subsidy (RDS) Application and Instructions (public, private and union sponsors)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 423 Subpart R

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS10156 Application Instructions.docx Yes No Printable Only
Form CMS-10156 RDS Application CMS10156 RDS Application 9_19.docx Yes Yes Fillable Printable

Health Health Care Services

Medicare Retiree Drug Subsidy Program (RDSP) System No.09-70-0550  70 FR 41035

1,245 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,245 0 0 -914 0 2,159
Annual IC Time Burden (Hours) 79,680 0 0 -58,496 0 138,176
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10156_RDSApplication_Track Change CMS10156RDSApplication GDIT edits 2024-05-24.docx 09/20/2024
CMS-10156_Application Instructions_Track Change CMS10156ApplicationInstructions GDIT edits 2024-05-24.docx 09/20/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.