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⚠️ Notice: This information collection may be referencing outdated material.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 1 340B Program Registrations & Certifications for Children's Hospitals Form and Instruction
1 340B Registration Children's and Free Standing Cancer Ho 340B Registration Children's and Free Standing Cancer Hospitals revised.pdf Form and Instruction
2 GPOform Revised GPOform Revised.pdf Form and Instruction
3 Cert state or local government Revised Cert state or local government Revised.pdf Form and Instruction
4 Public OWNERSHIP Revised Public OWNERSHIP Revised.pdf 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	1	340B Registration Children's and Free Standing Cancer Hospitals revised	340B Registration Children's and Free Standing Cancer Hospitals revised.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	GPOform Revised	GPOform Revised.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Cert state or local government Revised	Cert state or local government Revised.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	4	Public OWNERSHIP Revised	Public OWNERSHIP Revised.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12	-68	80
Annual IC Time Burden (Hours)	24	4	20
Annual IC Cost Burden (Dollars)	0	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.