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OPPS Drug Acquisition Cost Survey
Medicare Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey (CMS-10931)
OMB:
IC ID: 276343
OMB.report
CMS
ICR 202507-0938-017
IC 276343
( )
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
DRAFT Survey Template ODACS_FINAL.xlsx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
OPPS Drug Acquisition Cost Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
DRAFT Survey Template ODACS_FINAL.xlsx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,500
Number of Respondents for Small Entity:
3,000
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
3,500
0
3,500
0
0
0
Annual IC Time Burden (Hours)
257,250
0
257,250
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.