Information Collection

340B Program Registrations & Certifications for Children's Hospitals

IC 190346 under ICR 201006-0915-003 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 340B- 9a 340B Program Registrations & Certifications for Children's Hospitals	Form and Instruction
340B- 9a Hospital Registration Form 340B Registration-Childrens Hospital.doc	Form and Instruction
340B -9b Certification of State/Local Contract Certif State Local Contract-Childrens Hospital.doc	Form and Instruction
340B -9c Certification of Non GPO Certif NonParticip by Childrens Hosp in GPO.doc	Form and Instruction

IC Title:

340B Program Registrations & Certifications for Children's Hospitals

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 and Instruction	340B- 9a	Hospital Registration Form	340B Registration-Childrens Hospital.doc	Yes	No	Fillable Printable
Form and Instruction	340B -9b	Certification of State/Local Contract	Certif State Local Contract-Childrens Hospital.doc	Yes	No	Fillable Printable
Form and Instruction	340B -9c	Certification of Non GPO	Certif NonParticip by Childrens Hosp in GPO.doc	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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