OMB control number
Data Request and Attestation for PDP Sponsors (CMS-10691)
OMB 0938-1371 · HHS/CMS.
OMB 0938-1371
42 CFR 423.513(g)(1)(i) states that beginning in plan year 2020, a PDP sponsor may submit a request to CMS for the data described in paragraph (g)(2) about enrollees in its prescription drug plans. In addition, paragraph (g)(5) provides that as a condition of receiving the requested data, the PDP sponsor must attest that it will adhere to the permitted uses and limitations on the use of the Medicare claims data listed in paragraphs (g)(3) and (4).
The latest form for Data Request and Attestation for PDP Sponsors (CMS-10691) expires 2022-11-30 and is listed under ICR 201905-0938-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10691 Medicare A & B Claims Data to Part D Plan Sponsors API (AB2D) API Screens | Form and Instruction |
 CMS-10691 - Supporting Statement A.docx | Supporting Statement A |
 Data Request and Attestation for PDP Sponsors |
Form and Instruction |
| Data Request and Attestation for PDP Sponsors |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202602-0938-020 | Reinstatement without change of a previously approved collection | 2026-02-27 | ||
| 202209-0938-006 | Revision of a currently approved collection | 2022-09-30 | Approved without change | |
| 201905-0938-006 | New collection (Request for a new OMB Control Number) | 2019-05-14 | Approved without change |