OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Model Creditable Coverage Disclosure Notices

ICR 200810-0938-015 · OMB 0938-0990 · Historical Active

Forms and Documents
Document
Name
Status
Form and Instruction
 Modified
Supplementary Document
2008-10-08
Supporting Statement A
2008-10-08
IC Document Collections
IC ID
Document
Title
Status
8852 Modified
45715 Modified
45714 Modified
ICR Details
0938-0990 200810-0938-015
Historical Active 200805-0938-003
HHS/CMS
Model Creditable Coverage Disclosure Notices
Revision of a currently approved collection   No
Regular
Approved without change 12/24/2008
Retrieve Notice of Action (NOA) 10/29/2008
  Inventory as of this Action Requested Previously Approved
12/31/2011 36 Months From Approved 01/31/2009
1,225,173 0 1,225,173
522,204 0 522,204
0 0 0
The MMA requires that entities offering prescription drug benefits to Medicare Part D eligible individuals provide a disclosure of Creditable Coverage status of the plan that the individual is enrolled in or seeking to enroll in. CMS posted Model Disclosure Notices in May 2005 for entities to use between November 15, 2005 and May 15, 2006 (the initial enrollment period for Part D). Updated Model Disclosure Notices were posted in the Federal Register in May 2006 and CMS received one public comment. On February 15, 2007, CMS posted the OMB approved disclosure to CMS forms for use on or after February 15, 2007. CMS updated in 2008 the Model Disclosure Notices to make non-material changes and clarifications. This collection is to provide updated Model Disclosure Notices to be used beginning in 2009 as part of the renewal/reinstatement process. CMS recommends eliminating the Model Personalized Disclosure Notice to lessen the burden on the public. CMS has revised the Model Creditable Coverage Disclosure Notice and the Model Non-Creditable Coverage Disclosure Notice to incorporate the personalized information contained in the previously approved Model Personalized Disclosure Notice.
Statute at Large: 1 Stat. 1860 Name of Statute: null
  
None
Not associated with rulemaking
  73 FR 43449 07/25/2008
73 FR 57631 10/03/2008
No
  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 1,225,173 1,225,173 0 0 0 0
Annual Time Burden (Hours) 522,204 522,204 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$100,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Bonnie Harkless 4107865666
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/29/2008