National Average Drug Acquisition Cost (NADAC) Survey

Survey of Retail Prices (CMS-10241)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1041 can be found here:

Documents and Forms

Document Name Document Type
Dear_Pharmacy_Letter_508 Updated 7.9.2021.pdf Instruction
Dear_Pharmacy_Letter_508 Updated 7.9.2021.pdf Instruction
Survey Cover Sheet For Email_LP_508.pdf Other-Survey Cover Sheet
Survey Cover Sheet For Email_LP_508.pdf Other-Survey Cover Sheet
CMS-10241 National Average Drug Acquisition Cost (NADAC) Survey Re Survey_Tool_508 Updated 7.9.2021.pdf Form and Instruction
CMS-10241 National Average Drug Acquisition Cost (NADAC) Survey Re Survey_Tool_508 Updated 7.9.2021.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	National Average Drug Acquisition Cost (NADAC) Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Dear_Pharmacy_Letter_508 Updated 7.9.2021.pdf	Yes	No	Fillable Printable
Form and Instruction	CMS-10241	National Average Drug Acquisition Cost (NADAC) Survey Request for Information	Survey_Tool_508 Updated 7.9.2021.pdf	Yes	Yes	Fillable Printable
Other-Survey Cover Sheet			Survey Cover Sheet For Email_LP_508.pdf	No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 72,000	Number of Respondents for Small Entity: 21,024

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

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	72,000	42,000	30,000
Annual IC Time Burden (Hours)	36,000	21,000	15,000
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.