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)) Modified 15000 1245 0 Form and Instruction CMS-10141
Business Continuity Plans under 422.504(o) and 423.505(p) Unchanged 102 4680 0
Medicare Prescription Drug Benefit Program (Benes) Modified 4630100 1157525 0
Medicare Prescription Drug Benefit Program (Plans) Modified 81767836 24221864 593251773 Form and Instruction CMS-10141
Form and Instruction CMS-10141
Form and Instruction CMS-10141
Form and Instruction CMS-10141
Form and Instruction CMS-10141
Form and Instruction CMS-10141
Form and Instruction CMS-10141
Form and Instruction CMS-10141
Form and Instruction CMS-10141
State Eligibility Determinations (423.904(b)) and Reporting (423.910(d)) Modified 600102 13260 0
Utilization Management Committee and Health Equity 422.137 New 1663 10463 0
Total burden requested under this ICR: 87014803 25409037 593251773  
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