Information Collection Request

Medicaid Payment for Prescription Drugs - Physicians and Hospital Outpatient Departments Collecting and Submitting Drug Identifying Information to State Medicaid Programs (CMS-10215)

ICR 201011-0938-016 · OMB 0938-1026 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10215 Supporting Statement.doc Supporting Statement A Uploaded 2010-11-23 Available

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2014 36 Months From Approved 01/31/2011
3,910,000 0 3,910,400
16,227 0 15,837
0 0 336,294





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table that charts list of burden
IC Title Form No. Form Name
Medicaid Payment for Prescription Drugs - Physicians and Hospital Outpatient Departments Collecting and Submitting Drug Identifying Information to State Medicaid Programs (CMS-10215)

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 3,910,000 3,910,400 0 0 -400 0
Annual Time Burden (Hours) 16,227 15,837 0 0 390 0
Annual Cost Burden (Dollars) 0 336,294 0 0 -336,294 0


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