Information Collection

CMS-10710. GenIC #9 - Notice Testing: CMS Notice of Denial of Part D Drug Coverage (CMS-10146)

IC 267345 under ICR 202609-0938-011 · OMB 0938-1382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10146 Notice Testing Guide CMS-10710. GenIC #9 - Notice Testing: CMS Notice of Denial of Part D Drug Coverage (CMS-10146)	Form and Instruction
Form CMS-10146 Notice of Denial of Medicare Part D Drug Coverage CMS-10710. GenIC #9 - Notice Testing: CMS Notice of Denial of Part D Drug Coverage (CMS-10146)	Form and Instruction
CMS-10146 Notice Testing Guide CMS-10710.GenIC_#9-CMS10146_Instrument_0424.docx	Form and Instruction
CMS-10146 Notice of Denial of Medicare Part D Drug Coverage CMS-10710.GenIC_#9-CMS_10146_Standardized_for_testing_0424.docx	Form and Instruction
CMS-10710.GenIC_#9-ICR_Template_A11_Section 280_Clearance_(5-1-24).docx CMS-10710.GenIC_#9-ICR_Template_A11_Section 280_Clearance_(5-1-24)	IC Document

IC Title:

Agency IC Tracking Number:

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-10146				Yes	Yes	Fillable Printable
Form and Instruction	CMS-10146				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10710.GenIC_#9-ICR_Template_A11_Section 280_Clearance_(5-1-24)		05/01/2024

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

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