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Medicaid Drug Rebate Program - Manufacturers
Medicaid Drug Rebate Program - Manufacturers
OMB: 0938-0578
IC ID: 8181
OMB.report
HHS/CMS
OMB 0938-0578
ICR 200306-0938-004
IC 8181
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0578 can be found here:
2023-05-03 - Revision of a currently approved collection
2022-03-21 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
367C
Yes
Yes
Form
367A
Yes
Yes
Form
CMS-367
Yes
Yes
Federal Enterprise Architecture Business Reference Module
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
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
2,280
0
0
76
0
2,204
Annual IC Time Burden (Hours)
54,780
0
0
120
0
54,660
Annual IC Cost Burden (Dollars)
983,000
0
0
35,000
0
948,000
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.