View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-1385	ICR Reference No: 202405-0938-003
Status: Active	Previous ICR Reference No: 202106-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: [Medicaid] Annual State Report on Value Based Purchasing Arrangements (VBP) Supplemental Rebate Agreements (CMS-10722)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/07/2024
	Date Received in OIRA: 05/03/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years. CMCS/Division of Pharmacy should demonstrate that they have published collected information ahead of the reapproval of this package.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	36 Months From Approved	08/31/2024
Responses	51	0	51
Time Burden (Hours)	306	0	306
Cost Burden (Dollars)	0	0	0

Annual Cost to Federal Government: $5,124

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.