OPPS Drug Acquisition Cost Survey

Medicare Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey (CMS-10931)

Documents and Forms

Document Name Document Type
Form CMS-10931 OPPS Drug Acquisition Cost Survey Form and Instruction
CMS-10931 OPPS Drug Acquisition Cost Survey Survey Template_ODACS .xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	OPPS Drug Acquisition Cost Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10931	OPPS Drug Acquisition Cost Survey	Survey Template_ODACS .xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,500	Number of Respondents for Small Entity: 3,000

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	362,250	362,250
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.