Information Collection

Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534

IC 8184 under ICR 200707-0938-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CMS-367 a, b,c,d Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534	Form
PRA Instructions to Labelers for CMS 6-28-07.doc	Instruction
367 disclosure statement 6-28-07.doc	Other-Disclosure Statement
CMS-367 a, b,c,d Pricing Data revised 367 for omb 6-28-07.doc	Form
367Relevant Statute.doc Relevant Statute	IC Document

IC Title:

Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-367 a, b,c,d	Pricing Data	revised 367 for omb 6-28-07.doc	No	No	Fillable Fileable
Instruction			PRA Instructions to Labelers for CMS 6-28-07.doc	No	No	Printable Only
Other-Disclosure Statement			367 disclosure statement 6-28-07.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 540

Number of Respondents for Small Entity: 100

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	8,640	6,360	2,280
Annual IC Time Burden (Hours)	127,872	73,092	54,780
Annual IC Cost Burden (Dollars)	6,393,600	6,393,600	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Relevant Statute	367Relevant Statute.doc	02/20/2007

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