OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Part D Coordination of Benefits Data (CMS-10171)

OMB 0938-0978 ยท HHS/CMS.

OMB 0938-0978

This information is necessary to assist with coordination of prescription drug benefits provided to the Medicare beneficary at the pharmacy.

The latest form for Part D Coordination of Benefits Data (CMS-10171) expires 2028-07-31 and is listed under ICR 202504-0938-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
CMS-10171 - Supporting Statement A_.docxSupporting Statement A
CMS-10171 - Supporting Statement A_.docxSupporting Statement A
HealthHIV.pdfPublic Comments
COB ICR - CVS Health Comments 12_20_2024.pdfPublic Comments
CMS-10171-60-Day Comment Response.docxSupplementary Document
CMS-10171-60-Day Comment Response.docx Supplementary Document
Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202504-0938-002 Reinstatement without change of a previously approved collection 2025-05-13
202011-0938-014 Reinstatement without change of a previously approved collection 2020-12-09
201702-0938-016 Revision of a currently approved collection 2017-02-27 Approved with change
201311-0938-015 Revision of a currently approved collection 2013-11-14 Approved without change
201008-0938-009 Revision of a currently approved collection 2010-08-17 Approved without change
200906-0938-015 Revision of a currently approved collection 2009-06-25 Approved with change
200604-0938-001 Extension without change of a currently approved collection 2006-04-11 Approved without change
200601-0938-012 No material or nonsubstantive change to a currently approved collection 2006-01-20 Approved without change
200510-0938-004 New collection (Request for a new OMB Control Number) 2005-10-14 Approved without change