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Medicare Endorsed Prescription Drug Discount Card and Transitional Low-Income Assistance Program Response Form

IC 8749 under ICR 200310-0938-003 · OMB 0938-0909.

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Medicare Endorsed Prescription Drug Discount Card and Transitional Low-Income Assistance Program Response Form
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10100 Yes Yes


    

51 0
   
State, Local, and Tribal Governments
 
   100 %

  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 51 0 51 0 0 0
Annual IC Time Burden (Hours) 102 0 102 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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