Information Collection

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

IC 267328 under ICR 202404-0938-024 · OMB 0938-1473.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Supplemental to Form CMS-2552-10-i.PDF	Instruction
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
CMS-10897 SUPPLEMENTAL TO FORM CMS-2552-10 Supplemental to Form CMS-2552-10-f.PDF	Form and Instruction

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:

table that charts list of 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 %

table that charts list of burden
	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

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.