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: 0938-0976	ICR Reference No: 202303-0938-002
Status: Historical Active	Previous ICR Reference No: 202212-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Notice of Denial of Medicare Prescription Drug Coverage (CMS-10146)
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: 03/13/2023
	Date Received in OIRA: 03/02/2023
Terms of Clearance: Prior to the re-submission of the information collection “Notice of Denial of Medical Coverage (or Payment) (NDMCP) (CMS-10003)” (0938-0829), the agency will evaluate the burden, usability, and clarity of the forms and appeals process. This evaluation will be guided by the principles and priorities set forth in the memorandum titled “Improving Access to Public Benefits Programs Through the Paperwork Reduction Act” (April 13, 2022) https://www.whitehouse.gov/wp-content/uploads/2022/04/M-22-10.pdf. The assessment will inform and be integrated in the agency’s next submission of this information collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2024	06/30/2024	06/30/2024
Responses	2,627,898	0	2,627,898
Time Burden (Hours)	656,975	0	656,975
Cost Burden (Dollars)	0	0	0

Annual Cost to Federal Government: $1,260

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Stephan McKenzie 410 786-1943 stephan.mckenzie@cms.hhs.gov

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