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 202408-0938-030 · OMB 0938-1473.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10897 SUPPLEMENTAL TO FORM CMS-2552-10 Supplemental to Form CMS-2552-10 Payment Adjustment for Establishing and Maintaining Access to a Buffer Stock of Essential Medicines	Form and Instruction
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:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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					Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10897				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	500	500
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.

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