Information Collection Request

Survey of Retail Prices (CMS-10241)

ICR 202109-0938-001 · OMB 0938-1041 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10241 National Average Drug Acquisition Cost (NADAC) Survey Request for Information Form and Instruction Modified Available
CMS-10241 - Supporting Statement B (2021 version 2).docx Supporting Statement B Uploaded 2021-09-02 Repair queued
CMS-10241 - Supporting Statement A (2021 version 5).docx Supporting Statement A Uploaded 2021-09-02 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
201423 National Average Drug Acquisition Cost (NADAC) Survey Form and Instruction ModifiedNational Average Drug Acquisition Cost (NADAC) Survey Request for Information
201423 National Average Drug Acquisition Cost (NADAC) Survey Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2024 36 Months From Approved 10/31/2021
72,000 0 30,000
36,000 0 15,000
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
National Average Drug Acquisition Cost (NADAC) Survey CMS-10241

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 72,000 30,000 0 42,000 0 0
Annual Time Burden (Hours) 36,000 15,000 0 21,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No