View Information Collection (IC)

View Information Collection (IC)

IC Title:	National Average Drug Acquisition Cost (NADAC) Survey	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
Form and Instruction	CMS-10241	NADAC Survey Tool (English)	20230801_NADAC Survey Tool - Clean Version_508.docx		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10241	NADAC Survey Tool (Spanish)	20230314_NADAC Notificacion de Encuesta e Instrucciones_508.docx		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: 72,000	Number of Respondents for Small Entity: 21,024

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	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

Documents for IC

Title	Document	Date Uploaded
NADAC Survey Tool: Track Change	20230801_DRAFT NADAC Survey Tool - Redline Version.docx	10/20/2023
NADAC Survey Tool: Crosswalk	0938-1041 Survey of Retail Prices (CMS-10241) Survey Crosswalk_508_.xlsx	10/20/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.