OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medicare Drug Coverage and Your Rights (CMS-10147)

OMB 0938-0975 · HHS/CMS.

OMB 0938-0975

Pursuant to 42 CFR 423.562(a)(3) and 423.128(b)(7)(iii), Part D plan sponsors must arrange with their network pharmacies to provide a printed copy of the standardized pharmacy notice to enrollees (beneficiaries) at the point of sale when an enrollee's prescription cannot be filled.

The latest form for Medicare Drug Coverage and Your Rights (CMS-10147) expires 2027-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form
Supporting Statement A
Supplementary Document
All Historical Document Collections
 Extension without change of a currently approved collection 2024-11-05
Approved without change
 Reinstatement without change of a previously approved collection 2021-03-26
Approved without change
 No material or nonsubstantive change to a currently approved collection 2018-04-17
Approved with change
 Revision of a currently approved collection 2017-09-21
Approved without change
 Extension without change of a currently approved collection 2014-08-29
Approved without change
 No material or nonsubstantive change to a currently approved collection 2012-03-10
Approved with change
 Revision of a currently approved collection 2011-09-21
Approved without change
 Extension without change of a currently approved collection 2008-09-04
Approved without change
 No material or nonsubstantive change to a currently approved collection 2006-03-22
Approved with change
 New collection (Request for a new OMB Control Number) 2005-09-30