Information Collection

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

IC 8767 under ICR 201603-0938-002 · OMB 0938-0921.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.