Hospice Information for Medicare Part D Plans

Hospice Information for Medicare Part D Plans (CMS-10538)

Documents and Forms

Document Name Document Type
Form CMS-10538 Hospice Information for Medicare Part D Plans Form and Instruction
CMS-10538 Hospice Information for Medicare Part D Plans Form rev 03-08-2018 by OSORA_clean 3.4.25.docx Form and Instruction
Form rev_redline.pdf Hospice Information for Medicare Part D Plans - Track Change IC Document

Information Collection (IC) Details

IC Title:	Hospice Information for Medicare Part D Plans	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10538	Hospice Information for Medicare Part D Plans	Form rev 03-08-2018 by OSORA_clean 3.4.25.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 319	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	57,027	-319,460	376,487
Annual IC Time Burden (Hours)	2,329	-29,045	31,374
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Hospice Information for Medicare Part D Plans - Track Change	Form rev_redline.pdf	04/23/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.