National Average Drug Acquisition Cost (NADAC) Survey

Survey of Retail Prices (CMS-10241)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1041 can be found here:

Documents and Forms

Document Name Document Type
Dear_Pharmacy_Letter (rev 05-21-2018 by OSORA PRA).pdf Instruction
CMS-10241 National Average Drug Acquisition Cost (NADAC) Survey Re Survey Tool (rev 05-21-2018 by OSORA PRA).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	National Average Drug Acquisition Cost (NADAC) Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Dear_Pharmacy_Letter (rev 05-21-2018 by OSORA PRA).pdf		Yes	No	Fillable Printable
Form and Instruction	CMS-10241	National Average Drug Acquisition Cost (NADAC) Survey Request for Information	Survey Tool (rev 05-21-2018 by OSORA PRA).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,000	Number of Respondents for Small Entity: 8,760

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

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	15,000	15,000
Annual IC Cost Burden (Dollars)	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.