Information Collection Request

Hospital Survey for Specified Covered Outpatient Drugs (SCODs) (CMS-10709)

ICR 202008-0938-005 · OMB 0938-1374 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10709 Hospital Survey for Specified Covered Outpatient Drugs (SCODs) Form Unchanged Available
CMS-10709. Nonsub Change Justification - Final (8-11-20).docx Justification for No Material/Nonsubstantive Change Uploaded 2020-08-11 Available
CMS-10709. 340B Survey Characteristics Non-Response Bias Report.pdf Supplementary Document Uploaded 2020-08-10 Available
340B Survey 30 day Comment Response Clean (4-23-20).docx Supplementary Document Uploaded 2020-04-22 Available
CMS-10709.Supporting Statement Part A Clean (4-23-20).docx Supporting Statement A Uploaded 2020-04-22 Available
PRA Survey Proposal Crosswalk_02072020_Final.xlsx Supplementary Document Uploaded 2020-02-10 Available
CMS-10709.Supporting Statement Part B Clean (4-23-20).docx Supporting Statement B Uploaded 2020-04-22 Available
CMS Response to 340B Survey Comments_1292020_Clean.pdf Supplementary Document Uploaded 2020-02-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
239876 Hospital Survey for Specified Covered Outpatient Drugs (SCODs) Form Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2021 10/31/2021 10/31/2021
1,408 0 1,408
67,584 0 67,584
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Hospital Survey for Specified Covered Outpatient Drugs (SCODs) CMS-10709, CMS-10709 Drug Survey ,   Instruction Sheet for Collecting Acquisition Costs

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 1,408 1,408 0 0 0 0
Annual Time Burden (Hours) 67,584 67,584 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No