View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Medicaid Payment for Prescription Drugs - Physicians and Hospital Outpatient Departments Collecting and Submitting Drug Identifying Information to State Medicaid Programs (CMS-10215)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 447.520
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
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:
20,000
Number of Respondents for Small Entity:
20,000
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
45 %
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
3,910,400
3,910,400
0
0
0
0
Annual IC Time Burden (Hours)
15,837
15,837
0
0
0
0
Annual IC Cost Burden (Dollars)
336,294
336,294
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Bon Secours Health System
Bon Secours Health System.tif
07/19/2007
Charleston Area Medical Center
Charleston Area Medical Center.tif
07/19/2007
Columbus Regional Medical Center
Columbus Regional Medical Center.tif
07/19/2007
Federation of American Hospitals
Federation of American Hospitals.tif
07/19/2007
Gaston Memorial Hospital
Gaston Memorial Hospital.tif
07/19/2007
Grady Health System
Grady Health System.tif
07/19/2007
Hamilton Medical Center
Hamilton Medical Center.tif
07/19/2007
MCG Health System
MCG Health System.tif
07/19/2007
NorthOaks Health System
NorthOaks Health System.tif
07/19/2007
Phoenix Children's Hospital - Robert Meyer
Phoenix Children's Hospital - Robert Meyer.tif
07/19/2007
Phoenix Children's Hospital - Ken Cross
Phoenix Children's Hospital - Ken Cross.tif
07/19/2007
Phoenix Children's Hospital - Larry Smith
Phoenix Children's Hospital - Larry Smith.tif
07/19/2007
Providence Hospital
Providence Hospital.tif
07/19/2007
Rhode Island Hospital
Rhode Island Hospital.tif
07/19/2007
Santa Clara Valley
Santa Clara Valley.tif
07/19/2007
Shands Jacksonville
Shands Jacksonville.tif
07/19/2007
SHNPA
SHNPA.tif
07/19/2007
The Johns Hopkins Hospital DRA Reg Comment
The Johns Hopkins Hospital DRA Reg Comment.tif
07/19/2007
The Johns Hopkins Hospital
The Johns Hopkins Hospital.tif
07/19/2007
The Medical Center of Central Georgia
The Medical Center of Central Georgia.tif
07/19/2007
The Moses H
The Moses H. Cone Memorial Hospital.tif
07/19/2007
University of California, Davis
University of California, Davis.tif
07/19/2007
University of Michigan Hospitals and Health Centers
University of Michigan Hospitals and Health Centers.tif
07/19/2007
Wellstar Douglas Hospital
Wellstar Douglas Hospital.tif
07/19/2007
Women & Infants Hospital of Rhode Island
Women & Infants Hospital of Rhode Island.tif
07/19/2007
Response to Comments
pra packet comments and responses melissa june 5 07 (2).doc
07/19/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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