View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Notice of Denial of Medicare Prescription Drug Coverage (CMS-10146 and 10146SP)
 
No Modified
 
Mandatory
 
42 CFR 423.568(c) 42 CFR 423.568(d) 42 CFR 423.580 42 CFR 423.582

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes No Printable Only
Form CMS-10146 Yes No Fillable Printable
Form CMS-10146 Yes Yes Fillable Fileable

Health Health Care Services

 

456 0
   
Private Sector Businesses or other for-profits
 
   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 290,344 0 0 0 0 290,344
Annual IC Time Burden (Hours) 145,172 0 0 0 0 145,172
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Coverage Denial Notice Instructions TRACKED 5_27_2010 07/30/2010
Coverage Denial Notice TRACKED_06 2010 07/30/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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