OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

National Average Drug Acquisition Cost (NADAC) Survey

IC 201423 under ICR 202310-0938-004 · OMB 0938-1041.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

National Average Drug Acquisition Cost (NADAC) Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10241 NADAC Survey Tool (English) 20230801_NADAC Survey Tool - Clean Version_508.docx Yes Yes Fillable Printable
Form and Instruction CMS-10241 NADAC Survey Tool (Spanish) 20230314_NADAC Notificacion de Encuesta e Instrucciones_508.docx Yes Yes Fillable Fileable

Health Health Care Services

 

72,000 21,024
   
Private Sector Businesses or other for-profits
 
   70 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 72,000 0 0 0 0 72,000
Annual IC Time Burden (Hours) 36,000 0 0 0 0 36,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
NADAC Survey Tool: Track Change 20230801_DRAFT NADAC Survey Tool - Redline Version.docx 10/20/2023
NADAC Survey Tool: Crosswalk 0938-1041 Survey of Retail Prices (CMS-10241) Survey Crosswalk_508_.xlsx 10/20/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.