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Federal forms, ICRs, and supporting documents

Information Collection

Hospice Information for Medicare Part D Plans

IC 214736 under ICR 202504-0938-003 · OMB 0938-1269.

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

View Information Collection (IC)

Hospice Information for Medicare Part D Plans
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10538 Hospice Information for Medicare Part D Plans Form rev 03-08-2018 by OSORA_clean 3.4.25.docx No   Fillable Printable

Health Health Care Services

 

319 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 57,027 0 0 -319,460 376,487 0
Annual IC Time Burden (Hours) 2,329 0 0 -29,045 31,374 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Hospice Information for Medicare Part D Plans - Track Change Form rev_redline.pdf 04/23/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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