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:
0938-1475
ICR Reference No:
202507-0938-023
Status:
Active
Previous ICR Reference No:
202409-0938-010
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CM-CPC
Title:
Part C and Part D Medicare Prescription Payment Plan Model Documents (CMS-10882) - IRA
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/22/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/29/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2028
36 Months From Approved
12/31/2025
Responses
39,514,987
0
1,065
Time Burden (Hours)
135,080
0
21,300
Cost Burden (Dollars)
43,841,218
0
8,686,462
Abstract:
The purpose of this information collection request for the approval of model documents for the Medicare Prescription Drug Program (Part D) is to meet the requirements of Section 11202 of the Inflation Reduction Act of 2022, Public L. 117-169 (IRA), which established the Medicare Prescription Payment Plan Program. Under this program, MA Organizations offering Part D coverage and Part D sponsors are required to offer enrollees the option to pay their Part D cost sharing in monthly amounts spread out over the plan year based on the formula described in section 1860D-2(b)(2)(E)(iv) of the Act. There are several education and outreach requirements for plan sponsors related to implementation of this program. The proposed documents in this information collection are designed to assist Part D plan sponsors and MA organizations in complying with Sections 1860D-2(b)(2)(E)(v)(II) – (IV) of the Social Security Act (the Act), which set forth the education and outreach responsibilities for Part D sponsors and MA organizations for this program. CMS has developed the six materials in the attached package as model notices to provide standardized and consistent language for potential and active program participants, regardless of which Part D plan they may be enrolled in. CMS will require Part D plans to disseminate these notices, as appropriate, to Part D enrollees to fulfill the requirements of the Sections 1860D-2(b)(2)(E)(v)(II) – (IV) of the Act. The six model notices and their related burden are accounted for in this PRA package. By providing these model notices, CMS is providing standardized messaging for all Part D beneficiaries and reducing administrative burden on Part D sponsors and MA organizations.
Authorizing Statute(s):
PL:
Pub.L. 117 - 169 11202
Name of Law: Inflation Reduction Act of 2022
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:
90 FR 20304
05/13/2025
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 35529
07/28/2025
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
MPPP Model Notices Programming
CMS-10882, CMS-10882, CMS-10882, CMS-10882, CMS-10882, CMS-10882, CMS-10882, CMS-10882, CMS-10882, CMS-10882, CMS-10882, CMS-10882
Likely to Benefit Notice
,
Likely to Benefit Notice_ Spanish
,
Likely to Benefit Instructions
,
Medicare Prescription Payment Plan Participation Request Form
,
Part D Sponsor Notice to Acknowledge Acceptance of Election to the Medicare Prescription Payment Plan
,
Part D Sponsor Notice for Failure to Make Payments under the Medicare Prescription Payment Plan
,
Part D Sponsor Notice for Failure to Make Payments under Medicare Prescription Payment Plan – Notification of Termination of Participation in the Medicare Prescription Payment Plan
,
Part D Sponsor Notice of Voluntary Removal from the Medicare Prescription Payment Plan
,
Part D Sponsor Notice of Participation Renewal in the Medicare Prescription Payment Plan
,
Likely to Benefit Notice_ Chinese
,
Likely to Benefit Notice_ Vietnamese
,
Likely to Benefit Notice_ Korean
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
39,514,987
1,065
0
39,513,922
0
0
Annual Time Burden (Hours)
135,080
21,300
0
113,780
0
0
Annual Cost Burden (Dollars)
43,841,218
8,686,462
0
35,154,756
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Burden has increased due to added burden and revised burden associated with the Medicare Prescription Payment Plan that was not accounted for in previous PRA packages, including annual burden for Part D plan sponsors to comply with requirements to mail billing statements, annual burden for Part D plan sponsors to report their program-specific PCN starting with “MPPP” to CMS, one-time burden for Part D plan sponsors to set up systems for participation renewal, one-time burden for Part D plan sponsors to develop the Notice of Participation Renewal, and annual burden for Part D plan sponsors to update their systems to reflect changes to the likely to benefit criteria. We also added one-time beneficiary burden to complete the opt-out process and annual burden for pharmacies to provide the Likely to Benefit Notice.
Annual Cost to Federal Government:
$2,826
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.
No
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:
07/29/2025
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