Information Collection

Medicare Part D Reporting Requirements

IC 8853 under ICR 202411-0938-001 · OMB 0938-0992.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0992 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Non-Substantive Changes_CY2025_PartD RR_Clean_10.22.2024_.docx	Instruction
Non-Substantive Changes_CY2025_PartD RR_Clean_10.22.2024_.docx	Instruction
Non-Substantive Changes_CY2025_PartD RR_Redlined_10.22.2024_.docx CY2025_PartD RR_Track Change version	IC Document
Non-Substantive Changes_CY2025_PartD RR_Redlined_10.22.2024_.docx CY2025_PartD RR_Track Change version	IC Document

IC Title:

Medicare Part D Reporting Requirements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.514 42 CFR 423.505

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
Instruction					Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,019

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	14,325	14,325
Annual IC Time Burden (Hours)	23,094	23,094
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CY2025_PartD RR_Track Change version		11/01/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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