Annual State Report and Annual State Performance Rankings (CMS-10241)

Forms and Documents

Document Name	Status
Form CMS-10241 Annual State Report and Annual State Performance Rankings (CMS-10241) Form and Instruction	Modified
CMS-10241 Supporting Statement (Retail Price Survery PRA) [March 2011].doc Supporting Statement A	2011-03-10

IC Document Collections

IC ID	Document Title	Status
183391	Annual State Report and Annual State Performance Rankings (CMS-10241) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1041	ICR Reference No: 201103-0938-006
Status: Historical Active	Previous ICR Reference No: 200801-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Annual State Report and Annual State Performance Rankings (CMS-10241)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/25/2011
	Date Received in OIRA: 03/20/2011
Terms of Clearance: CMS must keep this form updated in conjunction with the related rule.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved	05/31/2011
Responses	51	0	51
Time Burden (Hours)	765	0	765
Cost Burden (Dollars)	0	0	0

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Abstract: Section 6001 of the Deficit Reduction Act of 2005 (DRA) requires CMS to contact with a vendor to conduct a monthly national survey of retail prescription drug prices and to report the prices to the States. These national average prices will be used as a benchmark by the States for the management of their prescription drug programs. The DRA requires that the States submit their individual pricing infomration for the 50 most prescribed drugs so that the States prices can be compared to the national average prices obtained from the survey. The States pricing inforamation will be compared and the States will be ranked. The law also requires that States report their drug utilization rates for noninnovator multiple source drugs, their payment rates under their State plan, and their dispending fees. A template will be used to facilitate data collection. The States rankings are to be presented to Congress and the States. The outlined deadlines must be met in order for the States to prepare the data requested. CMS contactors will require time to process the data and perform the rankings and prepare the report. CMS must review the report prior to its submission to Congress.

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Authorizing Statute(s): PL: Pub.L. 109 - 171 6001 Name of Law: Deficit Reduction Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 79000	12/17/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 12122	03/04/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Annual State Report and Annual State Performance Rankings (CMS-10241)	CMS-10241	State Payment and Utilization Rates and Performance Rankings Data Collection Form

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ICR Summary 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	51	51	0	0	0	0
Annual Time Burden (Hours)	765	765	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $5,197

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/20/2011

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