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Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers (CMS-10171)

IC 8840 under ICR 200906-0938-015 · OMB 0938-0978.

Documents and Forms
Document Name
Document Type
Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers (CMS-10171)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 423.464

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction PDP-Manual-Chapter 14_dis.pdf Yes Yes Paper Only

Health Health Care Services

 

56,988 0
   
Private Sector Businesses or other for-profits
 
   98 %

  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 2,153,767,270 0 0 0 0 2,153,767,270
Annual IC Time Burden (Hours) 1,017,914 0 0 0 0 1,017,914
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Final Automated TBT Guidance_dis Final Automated TBT Guidance_dis.pdf 05/21/2009
Instructions SPAP_dis Instructions SPAP_dis.pdf 05/21/2009
crosswalkCOB crosswalkCOB.doc 05/27/2009
Track Change TBT Guidance Updated Automated TBT Guidance v2_dis.pdf 05/21/2009
MDBGpraestimate_COB_5_28 MDBGpraestimate_COB_5_28.xls 05/27/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.