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

View Information Collection (IC)

Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers (CMS-10171)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 423.464

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes Yes Fillable Printable
Form CMS-10171 Yes Yes Fillable Printable
Instruction Yes No Fillable Printable

Health Health Care Services

 

57,116 0
   
Private Sector Businesses or other for-profits
 
   98 %

  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 2,402,582 0 0 2,154,564 0 248,018
Annual IC Time Burden (Hours) 5,205,128 0 0 4,450,340 0 754,788
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk 11/14/2013
Burden Estimate Table 11/14/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.