Information Collection Request

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

ICR 202508-0938-003 · OMB 0938-0921 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10110 Product Data Template Form Modified Repair queued
Form CMS-10110 Financial Data Template Form Modified Available
CMS-10110_Supporting_Statement_A_(CMS-1832-P_version_5)_clean.docx Supporting Statement A Uploaded 2025-09-12 Available
CMS-10110_Supporting_Statement_A_(CMS-1832-P_version_5)_clean.docx Supporting Statement A Uploaded 2025-09-12 Repair queued

ICR Details

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





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2
table that charts list of burden
IC Title Form No. Form Name
Average Sales Price: Price Concessions and Bona Fide Service Fees (§§ 414.802 and 414.804)
Manufacturers to Report Drug Pricing Information for Part B (§§ 414.802 and 414.902) CMS-10110, CMS-10110 ,  



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  No