Information Collection

National Average Drug Acquisition Cost (NADAC) Survey

IC 201423 under ICR 202109-0938-001 · OMB 0938-1041.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10241 National Average Drug Acquisition Cost (NADAC) Survey Request for Information National Average Drug Acquisition Cost (NADAC) Survey	Form and Instruction
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

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	No	Fillable Printable
Form and Instruction	CMS-10241	Yes	Yes	Fillable Printable
Other-Survey Cover Sheet		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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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