Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
MPPP Model Notices Programming Modified 1065 21300 8686462 Form and Instruction CMS-10882 Likely to Benefit Notice
Form and Instruction CMS-10882 Likely to Benefit Notice_ Spanish
Form and Instruction CMS-10882 Likely to Benefit Instructions
Form and Instruction CMS-10882 Medicare Prescription Payment Plan Participation Request Form
Form and Instruction CMS-10882 Part D Sponsor Notice to Acknowledge Acceptance of Election to the Medicare Prescription Payment Plan
Form and Instruction CMS-10882 Part D Sponsor Notice for Failure to Make Payments under the Medicare Prescription Payment Plan
Form and Instruction CMS-10882 Part D Sponsor Notice for Failure to Make Payments under Medicare Prescription Payment Plan – Notification of Termination of Participation in the Medicare Prescription Payment Plan
Form and Instruction CMS-10882 Part D Sponsor Notice of Voluntary Removal from the Medicare Prescription Payment Plan
Total burden requested under this ICR: 1065 21300 8686462  
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