Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) (CMS-10798)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10798 Application for Enrollment in Part B Immunosuppressive Drug Coverage	Form and Instruction	Modified	Available
Form CMS-10798 Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID)	Form and Instruction	Modified	Repair queued
CMS 10798 Supporting Statement A Clean.docx	Supporting Statement A	Uploaded 2025-05-28	Available
CMS 10798 Supporting Statement A Clean.docx	Supporting Statement A	Uploaded 2025-05-28	Repair queued
Aging and Long-Term Support Administration.pdf	Public Comments	Uploaded 2025-02-18	Available
CMS Response to Public Comments.docx	Supplementary Document	Uploaded 2025-05-23	Available
CMS Response to Public Comments.docx	Supplementary Document	Uploaded 2025-05-23	Repair queued
Crosswalk of Changes CMS 10798 508.pdf	Supplementary Document	Uploaded 2025-05-23	Available
Crosswalk of Changes CMS 10798 508.pdf	Supplementary Document	Uploaded 2025-05-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
254490	Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID)	Form and Instruction	Modified	Application for Enrollment in Part B Immunosuppressive Drug Coverage
254490	Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID)	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1428	ICR Reference No: 202505-0938-011
Status: Active	Previous ICR Reference No: 202302-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) (CMS-10798)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/07/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/18/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2028	36 Months From Approved
Responses	1,019	0	0
Time Burden (Hours)	173	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The CMS-10798 provides the necessary information to determine eligibility and to process the beneficiary’s request for enrollment for in Part B-ID coverage. This form is only used for enrollment by beneficiaries whose Medicare entitlement based on ESRD would otherwise end after a successful kidney transplant to continue enrollment under Medicare Part B only for the coverage of immunosuppressive drugs who already have Part A, but not Part B.

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Authorizing Statute(s): PL: Pub.L. 116 - 260 402 Name of Law: Consolidated Appropriations Act of 2021
  

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 104545	12/23/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 22490	05/28/2025
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
Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID)	CMS-10798	Application for Enrollment in Part B Immunosuppressive Drug Coverage

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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	1,019	0	0	0	252	767
Annual Time Burden (Hours)	173	0	0	0	45	128
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: The hourly burden from the 2023 approved submission increased from 128 hours to 173 hours, a change of 45. The change is due to a marginal increase in applicants from the 2023 submission to the 2024 submission .

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Annual Cost to Federal Government: $5,148

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: 06/18/2025

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