Information Collection Request

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

ICR 202604-0938-003 · OMB 0938-0921 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10110 Bona Fide Service Fee Certification Form Form Modified Available
Form CMS-10110 Reasonable Assumptions Form Form Modified Available
Form CMS-10110 Product Data Template Form Modified Available
Form CMS-10110 Financial Data Template Form Modified Available
CMS-10110_Supporting_Statement_A_(2026 version_24).docx Supporting Statement A Uploaded 2026-04-07 Available
PRA Comment Response.pdf Supplementary Document Uploaded 2026-04-07 Available
Comment - mm9-9h6c-2sao.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mke-jzg4-6xi2.pdf Public Comments Uploaded 2026-01-14 Available
Comment - ml8-kxgz-zc81.pdf Public Comments Uploaded 2026-02-04 Available
Comment - mm5-1c1a-5orr.pdf Public Comments Uploaded 2026-02-27 Available
Comment - mlk-wu0h-nksv.pdf Public Comments Uploaded 2026-02-13 Available
Comment - mlt-z5wp-r1xq.pdf Public Comments Uploaded 2026-02-19 Available
Comment - mm5-icnx-06c8.pdf Public Comments Uploaded 2026-02-27 Available
Comment - mm9-c3tq-fdcw.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mm9-c4st-223i.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mm9-gajc-diyq.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mm9-ggaq-9ihz.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mm9-ll4k-n3x8.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mm9-m1vm-p4si.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mm9-miot-vm18.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mm9-pr42-obo8.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mm9-toad-n88i.pdf Public Comments Uploaded 2026-03-02 Available
Comment - mma-3u1d-09ha.pdf Public Comments Uploaded 2026-03-02 Available

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 02/28/2029
4,500 3,000
49,500 38,500
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110) CMS-10110, CMS-10110, CMS-10110, CMS-10110 ,   ,   ,  

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,500 3,000 0 1,500 0 0
Annual Time Burden (Hours) 49,500 38,500 0 11,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No