340B Program Registrations & Certifications for Children's Hospitals

340B Drug Pricing Program Forms

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.