Prescription Drug File

Transparency in Pricing Information (CMS-10715)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1429 can be found here:

Documents and Forms

Document Name Document Type
CMS-10715-Transparency in Coverage_Appendix 4_.pdf Other-Data Elements
CMS-10715-Transparency in Coverage_Appendix 4_.pdf Other-Data Elements

Information Collection (IC) Details

IC Title:	Prescription Drug File	Agency IC Tracking Number:	CCIIO - 10715

Is this a Common Form? Yes		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 45 CFR 147.210(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements			CMS-10715-Transparency in Coverage_Appendix 4_.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 980	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	8,163	8,163
Annual IC Time Burden (Hours)	1,009,538	1,009,538
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.