Information Collection Request

Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110)

ICR 202304-0938-010 · OMB 0938-0921 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10110 Addendum B Form Modified Available
Form CMS-10110 ASP Addendum macro Form Modified Available
Response to Comments 60-day.docx Supplementary Document Uploaded 2023-04-17 Repair queued
CMS-10110_Supporting_Statement_A_.docx Supporting Statement A Uploaded 2023-04-17 Repair queued
CROSSWALK DOCUMENT FOR CMS 10110 011723.pdf Supplementary Document Uploaded 2023-04-17 Repair queued

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2026 36 Months From Approved 08/31/2024
2,000 0 1,200
26,000 0 15,600
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110) CMS-10110, CMS-10110 ,  

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 2,000 1,200 0 800 0 0
Annual Time Burden (Hours) 26,000 15,600 0 10,400 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No