OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Part D Drug Management Program (CMS-10874)

ICR 202412-0938-018 · OMB 0938-1465 · Received in OIRA

Forms and Documents
Document
Name
Status
Form
 Modified
Justification for No Material/Nonsubstantive Change
2024-12-26
Supporting Statement A
2024-08-08
IC Document Collections
IC ID
Document
Title
Status
264405 Modified
ICR Details
0938-1465 202412-0938-018
Received in OIRA 202408-0938-008
HHS/CMS CM-CPC
Part D Drug Management Program (CMS-10874)
No material or nonsubstantive change to a currently approved collection   No
Regular 12/26/2024
  Requested Previously Approved
11/30/2027 11/30/2027
62,248 62,248
152,585 152,585
0 0
Pursuant to Section 1860D-4(c)(5)(A) of the SSA, Part D sponsors will use the standardized and model documents to communicate with providers, enrollees, and other sponsors. Specifically, Part D sponsors may use the Model Part D Drug Management Program Prescriber Inquiry Letter to inform providers that their patient’s pattern of use or history of use of FADs is potentially unsafe and has prompted a case management review under the plan’s DMP. Part D sponsors must use the standardized Initial Notice and Second Notice, or Alternate Second Notice, to inform enrollees, following identification by CMS’s OMS and subsequent case management, whether the beneficiaries have been identified as being potentially at risk or at risk for abuse or misuse of FADs. Part D sponsors may use the Model Part D Drug Management Program Sponsor Information Transfer Memorandum to communicate to a gaining sponsor the enrollee’s history of misuse or abuse of FADs.
US Code: 42 USC 1860D-4(c)(5)(A) Name of Law: Social Security Act
  
None
0938-AV24 Final or interim final rulemaking 89 FR 30448 04/23/2024
  88 FR 78476 11/15/2023
89 FR 30448 04/23/2024
Yes
1
IC Title Form No. Form Name
Part D Drug Management Program CMS-10874, CMS-10874, CMS-10874, CMS-10874, CMS-10874 Initial Notice ,   Second Notice ,   Alternate Second Notice ,   Model Prescriber Inquiry Letter ,   Model Sponsor Information Transfer Memorandum
  Total Request 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 62,248 62,248 0 0 0 0
Annual Time Burden (Hours) 152,585 152,585 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new information collection request, in which we include information collection instruments and related requirements/burden from CMS-10141 (OMB control number 0938-0964) along with changes associated with our April 23, 2024 (89 FR 30448) final rule (CMS-4205-F, RIN 0938-AV24). Overall, the collection consists of: 319 respondents, 62,248 responses, and 152,585 hours.
$47,025
No
    No
    No
No
No
No
No
Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov
  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.
12/26/2024