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Medicare Part D Beneficiaries' Satisfaction on Potential Process Changes Associated With Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs) (CMS-10396)
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10396 Telephone Interview Script 4_Beneficiary Telephone Interview Guide 12022015.docx No   Fillable Printable
Other-Other-Visual Aid #2 ? Medication Action Plan Mockup 7_Visual Aid 2_MAP example.pdf No   Paper Only
Other-Beneficiary Solicitation Letter 3_Beneficiary Solicitation Letter [rev 12-11-2015 by OSORA PRA].docx No   Fillable Fileable Signable
Other-Visual Aid #3 ? Personal Medication List Mockup 8_Visual Aid 3_PML example.pdf No   Paper Only
Other-Visual Aid #1 ? Medicare & You 2016 MTM Pages 6_Visual Aid 1_Medicare & You_2016_MTM pages only.pdf No   Paper Only

Health Health Care Services

 

50 0
   
Individuals or Households
 
   0 %

  Requested 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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 17 0 0 0 0 17
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Submission Template - Supporting Statement 2_OMB Request Form Supporting Statement [rev 12-11-2015 by OSORA PRA].docx 12/29/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.