Information Collection Request

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

ICR 201710-0938-002 · OMB 0938-0921 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10110 Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110) Form Modified Repair queued
Disclosure Statement.doc Supplementary Document Uploaded 2017-10-04 Repair queued
Supporting Statement Part A 100417-Passback2 022218 (003).docx Supporting Statement A Uploaded 2018-02-23 Available

IC Document Collections

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2021 36 Months From Approved 08/31/2019
720 0 720
9,360 0 8,640
0 0 0





Reginfo record details
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table that charts list of burden
IC Title Form No. Form Name
Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110) CMS-10110, CMS-10110 Addendum B ,   ASP Addendum macro

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 720 720 0 0 0 0
Annual Time Burden (Hours) 9,360 8,640 0 0 720 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No