View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Survey of Retail Prices
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10241 Yes Yes Fillable Printable
Form and Instruction CMS-10241 Yes Yes Fillable Fileable

Health Health Care Services

 

72,000 21,024
   
Private Sector Businesses or other for-profits
 
   70 %

  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 72,000 0 0 0 0 72,000
Annual IC Time Burden (Hours) 36,000 0 0 0 0 36,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
REDLINE - Survey (English) 12/10/2025
REDLINE - Survey (Spanish) 12/10/2025
CROSSWALK - Survey 12/10/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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