Information Collection

Part D Manufacturer Discount Program

IC 260984 under ICR 202509-0938-022 · OMB 0938-1451.

Documents and Forms

Document Name Document Type
Form CMS-10846 Part D Manufacturer Discount Program Form and Instruction
Form CMS-10846 HPMS Data Entry Fields Part D Manufacturer Discount Program Form and Instruction
Form CMS-10846 TPA Data Entry Fields Part D Manufacturer Discount Program Form and Instruction
CMS-10846 HPMS Data Entry Fields Appendix A. Manufacturer Discount Program HPMS Data Entry Fields - CMS-10846.pdf Form and Instruction
CMS-10846 HPMS Data Entry Fields Appendix A. Manufacturer Discount Program HPMS Data Entry Fields - CMS-10846.pdf Form and Instruction
CMS-10846 TPA Data Entry Fields Appendix B. Manufacturer Discount Program TPA Data Entry Fields - CMS-10846.pdf Form and Instruction
CMS-10846 TPA Data Entry Fields Appendix B. Manufacturer Discount Program TPA Data Entry Fields - CMS-10846.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Part D Manufacturer Discount Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10846	HPMS Data Entry Fields	Appendix A. Manufacturer Discount Program HPMS Data Entry Fields - CMS-10846.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10846	TPA Data Entry Fields	Appendix B. Manufacturer Discount Program TPA Data Entry Fields - CMS-10846.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40	-619	659
Annual IC Time Burden (Hours)	320	-4,293	4,613
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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