View Information Collection Request (ICR) Package
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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:
0938-1441
ICR Reference No:
202504-0938-005
Status:
Active
Previous ICR Reference No:
202408-0938-003
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CM CPC
Title:
Transitional Coverage and Retroactive Medicare Part D Coverage for Certain Low-Income Beneficiaries through the Limited Income Newly Eligible Transition (LI NET) Program (CMS-10831)
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:
04/09/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/07/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2027
11/30/2027
11/30/2027
Responses
110,686
0
110,686
Time Burden (Hours)
11,701
0
11,701
Cost Burden (Dollars)
0
0
0
Abstract:
Section 118 of the Consolidated Appropriations Act, 2021 (CAA) (Public Law 116-260) enacted on December 27, 2020, amended Section 1860D-14 of the Social Security Act (the Act) (42 U.S.C. 1395w-114) and authorized CMS to make transitional coverage and retroactive Medicare Part D coverage for certain low-income beneficiaries, called the Limited Income Newly Eligible Transition (LI NET) program a permanent part of the Part D program. The LI NET program under this statute must begin no later than January 1, 2024.
Authorizing Statute(s):
PL:
Pub.L. 116 - 260 118
Name of Law: Consolidated Appropriations Act, 2021 (CAA)
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
89 FR 25879
04/12/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 63953
08/06/2024
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Beneficiaries
CMS-10831, CMS-10831, CMS-10831, CMS-10831, CMS-10831, CMS-10831, CMS-10831, CMS-10831, CMS-10831, CMS-10831
Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (English)
,
Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (English))
,
Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Chinese))
,
Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Chinese)
,
Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Korean))
,
Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Korean))
,
Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Spanish)
,
Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Spanish)
,
Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Vietnamese)
,
Direct Reimbursement Request for the Limited Inon (LI NET) Program ()come Newly Eligible Transition(Vietnamese)
Pharmacists (Fax the Documentation to the LI NET Sponsor)
Sponsor (Report to CMS)
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
110,686
110,686
0
0
0
0
Annual Time Burden (Hours)
11,701
11,701
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$11,304
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
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
04/07/2025
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