Information Collection

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

IC 181535 under ICR 201403-0938-006 · OMB 0938-1026.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1026 can be found here:

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Information Collection (IC) Details

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IC Title:	Medicaid Payment for Prescription Drugs - Physicians and Hospital Outpatient Departments Collecting and Submitting Drug Identifying Information to State Medicaid Programs (CMS-10215)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 447.520

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 20,000

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 45 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	3,910,000	3,910,000
Annual IC Time Burden (Hours)	16,227	16,227
Annual IC Cost Burden (Dollars)	0	0

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