OMB control number
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)
OMB 0938-1441 · HHS/CMS.
Section 118 of the Consolidated Appropriations Act, 2021 (CAA) (Public Law 116-260) enacted on December 27, 2020, amended Section 1860D-14 of the Social Security Act (the Act) (42 U.S.C. 1395w-114) and authorized CMS to make transitional coverage and retroactive Medicare Part D coverage for certain low-income beneficiaries, called the Limited Income Newly Eligible Transition (LI NET) program a permanent part of the Part D program. The LI NET program under this statute must begin no later than January 1, 2024.
The latest form for 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) expires 2027-11-30 and can be found here.
Document Name |
|---|
Form and Instruction |
Form and Instruction |
Supporting Statement A |
Supporting Statement A |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Form CMS-10831 Beneficiaries
CMS-10831_Supporting Statement__clean v2.docx
Sponsor (Report to CMS) |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2025-04-07 | |
| Revision of a currently approved collection | 2024-08-06 | ||
|
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2023-09-27 | |
|
Approved with change |
New collection (Request for a new OMB Control Number) | 2023-04-27 | |
|
Comment filed on proposed rule |
New collection (Request for a new OMB Control Number) | 2023-01-10 |
Beneficiaries
Federal Enterprise Architecture: Health - Health Care Services
| Form CMS-10831 | Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (English) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Direct Reimbursement Request for the Limited Inon (LI NET) Program ()come Newly Eligible Transition(Vietnamese) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Vietnamese) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Spanish) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Spanish) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Korean)) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Korean)) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Chinese) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Chinese)) | Fillable Fileable | Form and instruction |
| Form CMS-10831 | Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (English)) | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.