Information Collection Request

Medicare Prescription Drug Benefit Program - IRASA (CMS-10141)

ICR 202302-0938-009 · OMB 0938-0964 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0964 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10141 Preparation and Issuance of Model Notices (section 423.120(c)(6)) Form and Instruction	Modified
CMS-10141 - Supporting Statement A_IRASA reporting_.docx Supporting Statement A	2023-02-17
2023 Crosswalk for PRA 10141.pdf Supplementary Document	2023-02-15

IC Document Collections

IC ID	Document Title	Status
8823	Medicare Prescription Drug Benefit Program (Benes)	Modified
231341	Preparation and Issuance of Model Notices (section 423.120(c)(6)) Form and Instruction	Modified
217122	Business Continuity Plans under 422.504(o) and 423.505(p)	Modified
209891	State Eligibility Determinations (423.904(b)) and Reporting (423.910(d))	Modified
187164	Medicare Prescription Drug Benefit Program (Plans) Instruction	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-0964
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202204-0938-002
Agency Tracking No	CM-CPC
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31