Information Collection Request

Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 (CMS-367)

ICR 201203-0938-005 · OMB 0938-0578 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-367 Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 Form Modified Available
CMS-367 - Justification for Nonmaterial Change.doc Justification for No Material/Nonsubstantive Change Uploaded 2012-03-13 Available
CMS-367 Supporting Statement part A.doc Supporting Statement A Uploaded 2012-03-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8184 Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2013 11/30/2013 11/30/2013
9,280 0 9,280
137,344 0 137,344
8,240,640 0 10,000





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 CMS-367 CMS Record Specifications DDR

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 9,280 9,280 0 0 0 0
Annual Time Burden (Hours) 137,344 137,344 0 0 0 0
Annual Cost Burden (Dollars) 8,240,640 10,000 0 8,230,640 0 0


Reginfo record details
  No