Information Collection Request

Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations

ICR 200904-0938-009 · OMB 0938-0921 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CROSSWALK DOCUMENT FOR CMS 10110 110708.doc Supplementary Document Uploaded 2009-03-09 Available
Addendum B track changes document for 2009 renewal 112108.doc Supplementary Document Uploaded 2009-03-09 Available
ASPData revised _AddendumA revised 2009 with example data 112108.xls Supplementary Document Uploaded 2009-03-09 Available
ASPData revised _AddendumA revised 2009 with example data 110108.csv Supplementary Document Uploaded 2009-03-09 Available
Addendum B document for 2009 renewal 112108.doc Supplementary Document Uploaded 2009-03-09 Available
ASPData revised _AddendumA revised 2009 110108.csv Supplementary Document Uploaded 2009-03-09 Available
CMS-10110 Supporting Statement document for 2009 renewal 112108.doc Supporting Statement A Uploaded 2009-03-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8767 Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110) Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2012 36 Months From Approved 06/30/2009
720 0 480
28,800 0 17,760
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110) CMS-10110 Proposed Revised Addendum A

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 720 480 0 240 0 0
Annual Time Burden (Hours) 28,800 17,760 0 11,040 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No