Information Collection

Applicable Manufacturers and Applicable GPOs

IC 203245 under ICR 201207-0938-002 · OMB 0938-1173.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1173 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10442 Applicable Manufacturers and Applicable GPOs	Form and Instruction
CMS-10442 Reporting Templates Reporting Template (Dec11).xlsx	Form and Instruction

IC Title:

Applicable Manufacturers and Applicable GPOs

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 403.904 42 CFR 403.906

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10442	Reporting Templates	Reporting Template (Dec11).xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,570

Number of Respondents for Small Entity: 1,370

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	81,640	81,640
Annual IC Time Burden (Hours)	3,533,227	3,533,227
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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