View Information Collection (IC)

View Information Collection (IC)

IC Title:	Medicare Prescription Drug Benefit Program (Plan)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.2274(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Agent Compensation Information			CMS-10141.Attachment 4 (Agent Compensation Information Workbook)-11-07-08.xls		Yes	Yes	Paper Only
Other-Covered Agent Information			CMS-10141.Attachment 3 (Covered Agent Information Sheets Workbook)-11-07-08.xls		Yes	Yes	Paper Only
Other-Certification			CMS-10141.Attachments 1a-1b (Certifications)-11-07-08.doc		Yes	No	Paper Only
Other-Structure Submission			CMS-10141.Attachments 2a-2b (Structure Submission Form)-11-07-08.doc		Yes	Yes	Paper Only
Instruction			CMS-10141.Attachments 5a-5c (Instructions)-11-07-08.doc		Yes	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 87	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	0	0	-87	0	0	87
Annual IC Time Burden (Hours)	0	0	-4,263	0	0	4,263
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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