Information Collection

National Average Drug Acquisition Cost (NADAC) Survey

IC 201423 under ICR 202310-0938-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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	Form and Instruction
CMS-10241 NADAC Survey Tool (English) 20230801_NADAC Survey Tool - Clean Version_508.docx	Form and Instruction
CMS-10241 NADAC Survey Tool (English) 20230801_NADAC Survey Tool - Clean Version_508.docx	Form and Instruction
CMS-10241 NADAC Survey Tool (Spanish) 20230314_NADAC Notificacion de Encuesta e Instrucciones_508.docx	Form and Instruction
CMS-10241 NADAC Survey Tool (Spanish) 20230314_NADAC Notificacion de Encuesta e Instrucciones_508.docx	Form and Instruction
20230801_DRAFT NADAC Survey Tool - Redline Version.docx NADAC Survey Tool: Track Change	IC Document
20230801_DRAFT NADAC Survey Tool - Redline Version.docx NADAC Survey Tool: Track Change	IC Document
0938-1041 Survey of Retail Prices (CMS-10241) Survey Crosswalk_508_.xlsx NADAC Survey Tool: Crosswalk	IC Document
0938-1041 Survey of Retail Prices (CMS-10241) Survey Crosswalk_508_.xlsx NADAC Survey Tool: Crosswalk	IC Document

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.	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

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	Previously Approved
Annual Number of Responses for this IC	72,000	72,000
Annual IC Time Burden (Hours)	36,000	36,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.