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

IC 8767 under ICR 201112-0938-002 · OMB 0938-0921.

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Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations (CMS-10110)
 
No Modified
 
Mandatory
 
42 CFR 414 Subpart J Section 800-806

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10110 Average Sales Price (ASP) Addendum A TestASPAddendumAMacro_DRAFT for approval.xlsm Yes Yes Fillable Printable
Instruction LabelerTemplate Users Guide_DRAFT for approval.pdf Yes No Printable Only

Health Health Care Services

 

180 0
   
Private Sector Businesses or other for-profits
 
   95 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 720 0 0 0 0 720
Annual IC Time Burden (Hours) 34,560 0 5,760 0 0 28,800
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10110 Crosswalk CROSSWALK DOCUMENT FOR CMS 10110 FINAL.docx 12/05/2011
Disclosure Statement FINAL Disclosure Statement FINAL.docx 12/05/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.