Information Collection

OPPS Drug Acquisition Cost Survey

IC 276343 under ICR 202511-0938-014 · OMB 0938-1487.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1487 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10931 OPPS Drug Acquisition Cost Survey	Form and Instruction
Form CMS-10931 OPPS Drug Acquisition Cost Survey OPPS Drug Acquisition Cost Survey	Form and Instruction
CMS-10931 OPPS Drug Acquisition Cost Survey Survey Template_ODACS .xlsx	Form and Instruction
CMS-10931 OPPS Drug Acquisition Cost Survey Survey Template_ODACS .xlsx	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10931				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 %

table that charts list of burden
	Approved	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

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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