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 DRAFT Survey Template ODACS_FINAL.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: 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

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 Agency Discretion
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	257,250	257,250
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.