Information Collection

Requirement for Electronic Prescribing for Controlled Substances (EPCS) for a Covered Part D Drug Under a Prescription Drug Plan or an MA–PD Plan

IC 260452 under ICR 202512-0938-016 · OMB 0938-1455.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10834 EPCS Waiver Application Requirement for Electronic Prescribing for Controlled Substances (EPCS) for a Covered Part D Drug Under a Prescription Drug Plan or an MA–PD Plan	Form and Instruction
CMS-10834 EPCS Waiver Application CMS-10834 Appendix A _EPCS Waiver Application_508.pdf	Form and Instruction
CMS-10834 Crosswalk_clean.pdf Crosswalk	IC Document

IC Title:

Requirement for Electronic Prescribing for Controlled Substances (EPCS) for a Covered Part D Drug Under a Prescription Drug Plan or an MAâPD Plan

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-10834				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 306

Number of Respondents for Small Entity: 95

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
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	306	206	100
Annual IC Time Burden (Hours)	52	35	17
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk		12/15/2025

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

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