Hospital Survey for Specified Covered Outpatient Drugs (SCODs)

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

OMB: 0938-1374

IC ID: 239876

Information Collection (IC) Details

View Information Collection (IC)

Hospital Survey for Specified Covered Outpatient Drugs (SCODs)
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10709 Drug Survey SurveyWorksheet_CMS_ (4-23-20).xlsx Yes Yes Fillable Printable
Form and Instruction CMS-10709 Instruction Sheet for Collecting Acquisition Costs CMS-10709.Survey Instruction Clean (4-23-20).docx Yes Yes Fillable Printable

Health Health Care Services

 

1,408 0
   
State, Local, and Tribal Governments
 
   100 %

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

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