Information Collection

Prescription Drug File

IC 249775 under ICR 202110-0938-009 · OMB 0938-1372.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10715-Transparency in Coverage_Appendix 4_.pdf	Other-Data Elements
CMS-10715-Transparency in Coverage_Appendix 4_.pdf	Other-Data Elements

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 147.210(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements			CMS-10715-Transparency in Coverage_Appendix 4_.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 980

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	8,163	8,163
Annual IC Time Burden (Hours)	1,009,538	1,009,538
Annual IC Cost Burden (Dollars)	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.