Information Collection

Survey of Retail Community Pharmacy Invoice Prices

IC 201423 under ICR 201203-0938-002 · OMB 0938-1041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1041 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Dear Pharmacy Owner Letter 5-1-12 CLEAN.docx	Instruction
Survey Cover Sheet.docx	Other-Cover Sheet
1 NADAC Survey Tool NADAC Survey Tool 5-1-12 CLEAN (2)lr (2)lr (2).docx	Form and Instruction
Crosswalk RPS PRA.doc Crosswalk - Chnages to 30-day Survey Package	IC Document

IC Title:

Survey of Retail Community Pharmacy Invoice Prices

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Dear Pharmacy Owner Letter 5-1-12 CLEAN.docx	Yes	No	Fillable Printable
Other-Cover Sheet			Survey Cover Sheet.docx	Yes	No	Fillable Printable
Form and Instruction	1	NADAC Survey Tool	NADAC Survey Tool 5-1-12 CLEAN (2)lr (2)lr (2).docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 8,760

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	15,000	15,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk - Chnages to 30-day Survey Package	Crosswalk RPS PRA.doc	03/02/2012

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