View Information Collection (IC)

View Information Collection (IC)

IC Title:	MA-PDP Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 423.156

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-246	MA-Prescription Drug Plan Survey	MA-PDSurvey.pdf		No		Fillable Fileable
Form and Instruction	CMS-R-264	Prescription Drug Plan survey	PDPSurvey.pdf		No		Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privacy Act of 1974: HPMS # 09-70-4004	FR Citation: 63 FR 43187

Number of Respondents: 81,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	81,000	0	0	-16,500	0	97,500
Annual IC Time Burden (Hours)	13,770	0	0	-2,805	0	16,575
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.