Information Collection

MPPP Model Notices Programming

IC 267917 under ICR 202507-0938-023 · OMB 0938-1475.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10882 MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Likely to Benefit Notice MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Likely to Benefit Notice_ Spanish MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Likely to Benefit Instructions MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Medicare Prescription Payment Plan Participation Request Form MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Part D Sponsor Notice to Acknowledge Acceptance of Election to the Medicare Prescription Payment Plan MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Part D Sponsor Notice for Failure to Make Payments under the Medicare Prescription Payment Plan MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Part D Sponsor Notice for Failure to Make Payments under Medicare Prescription Payment Plan – Notification of Termination of Participation in the Medicare Prescription Payment Plan MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Part D Sponsor Notice of Voluntary Removal from the Medicare Prescription Payment Plan MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Part D Sponsor Notice of Participation Renewal in the Medicare Prescription Payment Plan MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Likely to Benefit Notice_ Chinese MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Likely to Benefit Notice_ Vietnamese MPPP Model Notices Programming	Form and Instruction
Form CMS-10882 Likely to Benefit Notice_ Korean MPPP Model Notices Programming	Form and Instruction
CMS-10882 Likely to Benefit Notice Exhibit 1_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice Exhibit 1_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice_ Spanish Exhibit 1.2_SPA_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice_ Spanish Exhibit 1.2_SPA_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Instructions Exhibit 1.3_Likely to Benefit Instructions_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Instructions Exhibit 1.3_Likely to Benefit Instructions_2025-.docx	Form and Instruction
CMS-10882 Medicare Prescription Payment Plan Participation Request Exhibit 2_Election Request_2025-.docx	Form and Instruction
CMS-10882 Medicare Prescription Payment Plan Participation Request Exhibit 2_Election Request_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice to Acknowledge Acceptance of Elect Exhibit 3_Notice of Election Approval_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice to Acknowledge Acceptance of Elect Exhibit 3_Notice of Election Approval_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice for Failure to Make Payments under Exhibit 4_Notice of Failure to Pay_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice for Failure to Make Payments under Exhibit 4_Notice of Failure to Pay_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice for Failure to Make Payments under Exhibit 5_Notice of Involuntary Termination_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice for Failure to Make Payments under Exhibit 5_Notice of Involuntary Termination_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice of Voluntary Removal from the Medi Exhibit 6_Notice of Voluntary Termination_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice of Voluntary Removal from the Medi Exhibit 6_Notice of Voluntary Termination_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice of Participation Renewal in the Me Exhibit 7_Notice of Participation Renewal_2025-.docx	Form and Instruction
CMS-10882 Part D Sponsor Notice of Participation Renewal in the Me Exhibit 7_Notice of Participation Renewal_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice_ Chinese Exhibit 1.4_CH_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice_ Chinese Exhibit 1.4_CH_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice_ Vietnamese Exhibit 1.5_VI_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice_ Vietnamese Exhibit 1.5_VI_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice_ Korean Exhibit 1.6_KO_Likely to Benefit Notice_2025-.docx	Form and Instruction
CMS-10882 Likely to Benefit Notice_ Korean Exhibit 1.6_KO_Likely to Benefit Notice_2025-.docx	Form and Instruction
Exhibit 1_Likely to Benefit Notice_2025_REDLINE.pdf Exhibit 1_Likely to Benefit Notice - Track Change	IC Document
Exhibit 1_Likely to Benefit Notice_2025_REDLINE.pdf Exhibit 1_Likely to Benefit Notice - Track Change	IC Document
Exhibit 2_Election Request_2025-_REDLINE.pdf Exhibit 2_Election Request - Track Change	IC Document
Exhibit 2_Election Request_2025-_REDLINE.pdf Exhibit 2_Election Request - Track Change	IC Document
Exhibit 3_Notice of Election Approval_2025-_REDLINE.pdf Exhibit 3_Notice of Election Approval - Track Change	IC Document
Exhibit 3_Notice of Election Approval_2025-_REDLINE.pdf Exhibit 3_Notice of Election Approval - Track Change	IC Document
Exhibit 4_Notice of Failure to Pay_2025-_REDLINE.pdf Exhibit 4_Notice of Failure to Pay_2025 - Track Change	IC Document
Exhibit 4_Notice of Failure to Pay_2025-_REDLINE.pdf Exhibit 4_Notice of Failure to Pay_2025 - Track Change	IC Document
Exhibit 5_Notice of Involuntary Termination_2025_REDLINE.pdf Exhibit 5_Notice of Involuntary Termination - Track Change	IC Document
Exhibit 5_Notice of Involuntary Termination_2025_REDLINE.pdf Exhibit 5_Notice of Involuntary Termination - Track Change	IC Document
Exhibit 6_Notice of Voluntary Termination_2025_REDLINE.pdf Exhibit 6_Notice of Voluntary Termination - Track Change	IC Document
Exhibit 6_Notice of Voluntary Termination_2025_REDLINE.pdf Exhibit 6_Notice of Voluntary Termination - Track Change	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

MPPP Model Notices Programming

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10882	Yes	No	Printable Only
Form and Instruction	CMS-10882	Yes	No	Printable Only
Form and Instruction	CMS-10882	Yes	No	Printable Only
Form and Instruction	CMS-10882	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10882	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10882	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10882	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10882	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10882	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10882	Yes	No	Fillable Printable
Form and Instruction	CMS-10882	Yes	No	Fillable Printable
Form and Instruction	CMS-10882	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 840

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	39,514,987	39,513,922	1,065
Annual IC Time Burden (Hours)	135,080	113,780	21,300
Annual IC Cost Burden (Dollars)	43,841,218	35,154,756	8,686,462

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Exhibit 1_Likely to Benefit Notice - Track Change		07/23/2025
Exhibit 2_Election Request - Track Change		07/23/2025
Exhibit 3_Notice of Election Approval - Track Change		07/23/2025
Exhibit 4_Notice of Failure to Pay_2025 - Track Change		07/23/2025
Exhibit 5_Notice of Involuntary Termination - Track Change		07/23/2025
Exhibit 6_Notice of Voluntary Termination - Track Change		07/23/2025

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

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