OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicare Prescription Drug Coverage and Your Rights (CMS-10147 and 10147SP)

IC 37927 under ICR 200809-0938-001 · OMB 0938-0975.

Documents and Forms
Document Name
Document Type
Form
Instruction
Other-Form Track Changes
Instruction
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Medicare Prescription Drug Coverage and Your Rights (CMS-10147 and 10147SP)
 
No Modified
 
Mandatory
 
42 CFR 423.562(a)(3)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10147SP SUS DERECHOS Y LA COBERTURA DE MEDICARE DE RECETAS M?DICAS Supporting Statement 10147 Pharmacy Notice - Part A 04 29 2008.doc Yes Yes Paper Only
Instruction SP-Spanish Instructions for Pharmacy Notice_06 12 2008.doc Yes Yes Paper Only
Form CMS-10147 MEDICARE PRESCRIPTION DRUG COVERAGE AND YOUR RIGHTS Pharmacy Notice 10147 rev CLEAN 04 29 2008.doc Yes Yes Paper Only
Other-Form Track Changes Pharmacy Notice 10147 rev TRACKED 04 29 2008.doc Yes Yes Paper Only
Instruction Instructions for Pharmacy Notice_04 29 2008.doc Yes Yes Paper Only

Health Health Care Services

 

40,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 30,000,000 0 0 -5,000,000 0 35,000,000
Annual IC Time Burden (Hours) 500,000 0 0 -83,333 0 583,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.