Information Collection

Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110)

IC 8767 under ICR 200904-0938-009 · OMB 0938-0921.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0921 can be found here:

Documents and Forms

Document Name Document Type
Appendix A data elements guide revised 110108.doc Instruction
CMS-10110 Proposed Revised Addendum A ASPData revised _AddendumA revised 2009 112108.xls Form
ASPData revised _AddendumA revised 2009 110108.csv ASPData revised _AddendumA revised 2009 110108 IC Document
Addendum B document for 2009 renewal 112108.doc Addendum B document for 2009 renewal 112108 IC Document
ASPData revised _AddendumA revised 2009 with example data 110108.csv ASPData revised _AddendumA revised 2009 with example data 110108 IC Document
ASPData revised _AddendumA revised 2009 with example data 112108.xls ASPData revised _AddendumA revised 2009 with example data 112108 IC Document
Addendum B track changes document for 2009 renewal 112108.doc Addendum B track changes document for 2009 renewal 112108 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414 Subpart J Section 800-806

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Appendix A data elements guide revised 110108.doc		Yes	Yes	Paper Only
Form	CMS-10110	Proposed Revised Addendum A	ASPData revised _AddendumA revised 2009 112108.xls		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	720	240	480
Annual IC Time Burden (Hours)	28,800	11,040	17,760
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ASPData revised _AddendumA revised 2009 110108	ASPData revised _AddendumA revised 2009 110108.csv	03/09/2009
Addendum B document for 2009 renewal 112108	Addendum B document for 2009 renewal 112108.doc	03/09/2009
ASPData revised _AddendumA revised 2009 with example data 110108	ASPData revised _AddendumA revised 2009 with example data 110108.csv	03/09/2009
ASPData revised _AddendumA revised 2009 with example data 112108	ASPData revised _AddendumA revised 2009 with example data 112108.xls	03/09/2009
Addendum B track changes document for 2009 renewal 112108	Addendum B track changes document for 2009 renewal 112108.doc	03/09/2009

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