Supplemental to Form CMS-2552-10 Payment Adjustment for Establishing and Maintaining Access to a Buffer Stock of Essential Medicines

Supplemental to Form CMS-2552-10 Payment Adjustment for Establishing and Maintaining Access to Buffer Stock of Essential Medicines (CMS-10897)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1473 can be found here:

Documents and Forms

Document Name Document Type
Supplemental to Form CMS-2552-10-i.PDF Instruction
CMS-10897 SUPPLEMENTAL TO FORM CMS-2552-10 Supplemental to Form CMS-2552-10-f.PDF Form and Instruction

Information Collection (IC) Details

IC Title:	Supplemental to Form CMS-2552-10 Payment Adjustment for Establishing and Maintaining Access to a Buffer Stock of Essential Medicines	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Supplemental to Form CMS-2552-10-i.PDF		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10897	SUPPLEMENTAL TO FORM CMS-2552-10	Supplemental to Form CMS-2552-10-f.PDF		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 493	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	493	493
Annual IC Time Burden (Hours)	493	493
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.