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 (CMS-10110)

OMB: 0938-0921

IC ID: 8767

Information Collection (IC) Details

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Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110)
 
No Modified
 
Mandatory
 
42 CFR 414 Subpart J Section 800-806

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction cms10110.asp_data_collection_validation_macro_user_guide_032520.pdf Yes Yes Printable Only
Instruction cms10110.asp_user_guide_end_users_v2_0.pdf Yes Yes Printable Only
Form CMS-10110 ASP Addendum macro CMS-10110.aspaddendumamacro_final_.xlsm Yes Yes Fillable Fileable
Form CMS-10110 Addendum B cms10110._asp_addendum_b_032520.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

300 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested 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 1,200 0 0 480 0 720
Annual IC Time Burden (Hours) 15,600 0 0 6,240 0 9,360
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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