Information Collection Request

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

ICR 202405-0938-015 · OMB 0938-0921 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10110 Product Data Template Form Modified Available
Form CMS-10110 Financial Data Template Form Modified Available
CMS-10110_Supporting_Statement_A.docx Supporting Statement A Uploaded 2024-05-14 Repair queued
Crosswalk Document for CMS 10110 -20240130.pdf Supplementary Document Uploaded 2024-05-14 Repair queued

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2027 36 Months From Approved 08/31/2026
2,000 0 2,000
26,000 0 26,000
0 0 0





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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 2,000 0 0 0 0
Annual Time Burden (Hours) 26,000 26,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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