Part D Coordination of Benefits Data (CMS-10171)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10171 - Supporting Statement A_.docx	Supporting Statement A	Uploaded 2025-05-12	Available
CMS-10171 - Supporting Statement A_.docx	Supporting Statement A	Uploaded 2025-05-12	Repair queued
HealthHIV.pdf	Public Comments	Uploaded 2024-12-03	Available
COB ICR - CVS Health Comments 12_20_2024.pdf	Public Comments	Uploaded 2024-12-20	Available
CMS-10171-60-Day Comment Response.docx	Supplementary Document	Uploaded 2025-04-02	Available
CMS-10171-60-Day Comment Response.docx	Supplementary Document	Uploaded 2025-04-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8840	Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers	Instruction	Modified

ICR Details

OMB Control No: 0938-0978	ICR Reference No: 202504-0938-002
Status: Active	Previous ICR Reference No: 202011-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Part D Coordination of Benefits Data (CMS-10171)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/28/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/13/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2028	36 Months From Approved
Responses	994,985,729	0	0
Time Burden (Hours)	315,908	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information is necessary to assist with coordination of prescription drug benefits provided to the Medicare beneficary at the pharmacy.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 101 Name of Law: Part D- Voluntary Prescription Drug Benefit Program
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 84154	10/21/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 20166	05/12/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	994,985,729	0	0	0	246,419,159	748,566,570
Annual Time Burden (Hours)	315,908	0	0	0	-623,060	938,968
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: CMS calculates a decrease in annual burden from 938,968 hours to 315,908 hours and a decrease in cost. Estimates reflect actual data from the PDTF and CMS believes number of eligibility (E1) transactions (333,178,054 in the previously approved collection vs. 57,438,000 according to 2024 data from PDTF) disproportionally affected the total burden calculations for this collection in the previous revision.

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Annual Cost to Federal Government: $27,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/13/2025

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