Information Collection

Hospice Information for Medicare Part D Plans

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10538 Hospice Information for Medicare Part D Plans	Form and Instruction
Form CMS-10538 Hospice Information for Medicare Part D Plans Hospice Information for Medicare Part D Plans	Form and Instruction
CMS-10538 Hospice Information for Medicare Part D Plans Form rev 03-08-2018 by OSORA_clean 3.4.25.docx	Form and Instruction
CMS-10538 Hospice Information for Medicare Part D Plans Form rev 03-08-2018 by OSORA_clean 3.4.25.docx	Form and Instruction
Form rev_redline.pdf Hospice Information for Medicare Part D Plans - Track Change	IC Document
Form rev_redline.pdf Hospice Information for Medicare Part D Plans - Track Change	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	CMS-10538				No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 319

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	57,027	-319,460	376,487
Annual IC Time Burden (Hours)	2,329	-29,045	31,374
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Hospice Information for Medicare Part D Plans - Track Change		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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