Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0921 can be found here:

Documents and Forms

Document Name Document Type
ASP_Data_Collection_Validation_Macro_User_Guide-DAS-ASPPRA.pdf Instruction
CMS-10110 Test_ASP_Addendum_A_MACRO Copy of CMS-10110 Test_ASP_Addendum_A_Macro_DRAFT (Revised 8-10-16).xlsm Form

Information Collection (IC) Details

IC Title:	Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414 Subpart J Section 800-806

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			ASP_Data_Collection_Validation_Macro_User_Guide-DAS-ASPPRA.pdf		Yes	No	Printable Only
Form	CMS-10110	Test_ASP_Addendum_A_MACRO	Copy of CMS-10110 Test_ASP_Addendum_A_Macro_DRAFT (Revised 8-10-16).xlsm		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	720	0	720
Annual IC Time Burden (Hours)	8,640	-25,920	34,560
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.