Information Collection Request

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

ICR 201112-0938-002 · OMB 0938-0921 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10110 Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110) Form Modified Available
Disclosure Statement FINAL.docx Supplementary Document Uploaded 2011-12-05 Available
CROSSWALK DOCUMENT FOR CMS 10110 FINAL.docx Supplementary Document Uploaded 2011-12-05 Available
CMS-10110 Supporting Statement part A [rev 12-05-2011].doc Supporting Statement A Uploaded 2011-12-05 Available

IC Document Collections

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2015 36 Months From Approved 06/30/2012
720 0 720
34,560 0 28,800
0 0 0





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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 Average Sales Price (ASP) 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 720 720 0 0 0 0
Annual Time Burden (Hours) 34,560 28,800 0 5,760 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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