View Information Collection (IC)

View Information Collection (IC)

IC Title:	Survey of Retail Community Pharmacy Invoice Prices	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Instruction			Dear Pharmacy Owner Letter 12-2014 CLEAN.PDF		Yes	No	Fillable Printable
Other-Cover Sheet			Survey Cover Sheet 12-2014.pdf		Yes	No	Fillable Printable
Form and Instruction	1	NADAC Survey Tool	NADAC Survey Tool 12-2014 CLEAN.PDF		Yes	Yes	Fillable Printable

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: 30,000	Number of Respondents for Small Entity: 8,760

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 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	30,000	0	0	0	0	30,000
Annual IC Time Burden (Hours)	15,000	0	0	0	0	15,000
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.