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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Preparation and Issuance of Model Notices (section 423.120(c)(6))
Unchanged
95000
7885
0
Business Continuity Plans under 422.504(o) and 423.505(p)
Unchanged
99
15920
0
Creation of Model Notices (Plans) (section 423.120(c)(6))
Unchanged
212
636
0
Medicare Prescription Drug Benefit Program (Benes)
Unchanged
9869100
2847975
0
Medicare Prescription Drug Benefit Program (Plans)
Modified
43863133
5690947
0
Form
CMS-10141
Compensation Certification
Instruction
Form
CMS-10141
Description of Compensation Structure
Form
CMS-10141
Covered Agent Information Sheets Workbook
Form
CMS-10141
Compensation Structure for Writing Agents by Contract/PBP Number
Form
CMS-10141
Initial Notice: Notice of Intent to Limit Your Access to Certain Part D Drugs
Form
CMS-10141
Second Notice: Your Access to Certain Part D Drugs is Limited
Form
CMS-10141
Alternate Second Notice
Instruction
Form
CMS-10141
2019 Part C and D Sample Precluded Provider Letter
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
State Eligibility Determinations (423.904(b)) and Reporting (423.910(d))
Unchanged
600102
13260
0
System Programming (Plans) (section 423.120(c)(6))
Unchanged
30
93600
0
Total burden requested under this ICR:
54427676
8670223
0
To view an IC, click on IC Title