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

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0578 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-367 Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 Form
CMS-367 Instructions to Labelers.doc Instruction
CMS-367 disclosure statement.doc Other-Disclosure Statement
CMS-367 CMS Record Specifications DDR CMS-367 Record File Layout.doc Form

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-367	CMS Record Specifications DDR	CMS-367 Record File Layout.doc	Yes	Yes	Fillable Fileable
Instruction			CMS-367 Instructions to Labelers.doc	Yes	No	Printable Only
Other-Disclosure Statement			CMS-367 disclosure statement.doc	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 580	Number of Respondents for Small Entity: 100

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,280	0	9,280
Annual IC Time Burden (Hours)	137,344	0	137,344
Annual IC Cost Burden (Dollars)	8,240,640	8,230,640	10,000

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.