Identifying Medicaid Payment for Physician Administered Drugs

Identifying Medicaid Payment for Physician Administered Drugs (CMS-10215)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1026 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Identifying Medicaid Payment for Physician Administered Drugs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 447.520

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 20,000

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 96 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	84,589,433	80,679,433	3,910,000
Annual IC Time Burden (Hours)	351,046	334,819	16,227
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.