Survey of Retail Community Pharmacy Invoice Prices

Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings (CMS-10241)

OMB: 0938-1041

IC ID: 201423

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Survey of Retail Community Pharmacy Invoice Prices
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Dear Pharmacy Owner Letter 12-2014 CLEAN.PDF Yes No Fillable Printable
Other-Cover Sheet Survey Cover Sheet 12-2014.pdf Yes No Fillable Printable
Form and Instruction 1 NADAC Survey Tool NADAC Survey Tool 12-2014 CLEAN.PDF Yes Yes Fillable Printable

Health Health Care Services

 

30,000 8,760
   
Private Sector Businesses or other for-profits
 
   70 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30,000 0 0 0 0 30,000
Annual IC Time Burden (Hours) 15,000 0 0 0 0 15,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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