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

⚠️ Notice: This information collection may be referencing outdated material.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
cms10110.asp_data_collection_validation_macro_user_guide_032520.pdf Instruction
cms10110.asp_user_guide_end_users_v2_0.pdf Instruction
CMS-10110 ASP Addendum macro CMS-10110.aspaddendumamacro_final_.xlsm Form
CMS-10110 Addendum B cms10110._asp_addendum_b_032520.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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	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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,200	480	720
Annual IC Time Burden (Hours)	15,600	6,240	9,360
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.