The NCPDP Universal Pharmacy Billing Form

The NCPDP Universal Pharmacy Billing Form

OMB: 1215-0194

IC ID: 13925

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The NCPDP Universal Pharmacy Billing Form
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 79-1A Yes Yes


    

594,974 0
   
Private Sector Businesses or other for-profits
 
   19 %

  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 594,974 0 230,608 -41,832 0 406,198
Annual IC Time Burden (Hours) 49,382 0 19,140 -3,472 0 33,714
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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