View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0975	ICR Reference No: 201203-0938-003
Status: Historical Active	Previous ICR Reference No: 201109-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Standardized Pharmacy Notice: Your Prescription Cannot be Filled (f/k/a Medicare Prescription Drug Coverage and Your Rights)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/12/2012
	Date Received in OIRA: 03/10/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	01/31/2015	01/31/2015
Responses	37,087,402	0	37,087,402
Time Burden (Hours)	617,876	0	617,876
Cost Burden (Dollars)	0	0	0

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