Notice of Denial of Medicare Prescription Drug Coverage (CMS-10146)

Notice of Denial of Medicare Prescription Drug Coverage (CMS-10146)

OMB: 0938-0976

IC ID: 37928

Information Collection (IC) Details

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Notice of Denial of Medicare Prescription Drug Coverage (CMS-10146)
 
No Modified
 
Mandatory
 
42 CFR 423.580 42 CFR 423.582 42 CFR 423.568(c) 42 CFR 423.568(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Denial Notice Instructions 2020 60 day v508.pdf No   Printable Only
Form CMS-10146 Notice of Denial of Medicare Part D Prescription Drug Coverage Denial Notice 2020 30 day FINAL.docx Yes No Fillable Printable

Health Health Care Services

 

525 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,887,866 0 0 985,811 1,902,055 0
Annual IC Time Burden (Hours) 721,967 0 0 246,453 475,514 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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