STATE DRUG REBATE (MEDICAID)

ICR 199104-0938-001

OMB: 0938-0582

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
114030 Migrated
ICR Details
0938-0582 199104-0938-001
Historical Active
HHS/CMS
STATE DRUG REBATE (MEDICAID)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/12/1991
Retrieve Notice of Action (NOA) 04/09/1991
This information collection submitted by HCFA for emergency review is cleared for 90 days per the regulations in 5 CFR 1320.18.
  Inventory as of this Action Requested Previously Approved
07/31/1991 07/31/1991
51 0 0
6,171 0 0
0 0 0

OBRA 1990 REQUIRES STATE MEDICAID AGENCIES TO REPORT TO DRUG MANUFACTURERS AND HCFA ON THE DRUG UTILIZATION FOR THEIR STATE AND THE AMOUNT OF REBATE TO BE PAID BY THE MANUFACTURERS.

None
None


No

1
IC Title Form No. Form Name
STATE DRUG REBATE (MEDICAID) HCFA 368, HCFA R-144

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 51 0 0 51 0 0
Annual Time Burden (Hours) 6,171 0 0 6,171 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/09/1991


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