Information Collection Request
Transitional Coverage and Retroactive Medicare Part D Coverage for Certain Low-Income Beneficiaries through the Limited Income Newly Eligible Transition (LI NET) Program (CMS-10831)
ICR 202504-0938-005 · OMB 0938-1441 · Active
Forms and Documents
Document Name | Status |
|---|---|
Form and Instruction |
Modified |
Form and Instruction |
Modified |
Supporting Statement A | 2025-04-04 |
Supporting Statement A | 2025-04-04 |
Justification for No Material/Nonsubstantive Change | 2025-04-04 |
Justification for No Material/Nonsubstantive Change | 2025-04-04 |
Form CMS-10831 Beneficiaries
CMS-10831_Supporting Statement__clean v2.docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 257782 | Unchanged | ||
| 257781 | Unchanged | ||
| 257780 | Modified | ||
| 257780 | Modified |
Sponsor (Report to CMS)ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1441 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202408-0938-003 |
| Agency Tracking No | CM CPC |
| Date Submitted to OIRA | 2025-04-07 |
| Requested Expiration Date | 1969-12-31 |