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Standardized Pharmacy Notice

IC 37927 under ICR 202410-0938-020 · OMB 0938-0975.

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Instruction
Instruction
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Standardized Pharmacy Notice
 
No Modified
 
Mandatory
 
42 CFR 423.562(a)(3) 42 CFR 128(b)(7)(iii)  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10147 Medicare Drug Coverage and Your Rights Pharmacy Notice_CMS 10147.docx No   Fillable Printable
Instruction Pharmacy Notice Instructions_.docx No   Printable Only

Health Health Care Services

 

72,900 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 55,215,940 0 0 5,534,648 0 49,681,292
Annual IC Time Burden (Hours) 919,898 0 0 92,208 0 827,690
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Pharmacy Notice_Track Change Pharmacy Notice_CMS 10147_508ed - redline.docx 10/21/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.