Information Collection

Medicaid Drug Rebate Program - Manufacturers

IC 8181 under ICR 200306-0938-004 · OMB 0938-0578.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0578 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Medicaid Drug Rebate Program - Manufacturers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	367C	Yes	Yes
Form	367A	Yes	Yes
Form	CMS-367	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 570	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 85 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,280	76	2,204
Annual IC Time Burden (Hours)	54,780	120	54,660
Annual IC Cost Burden (Dollars)	983,000	35,000	948,000

Documents for IC

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