Annual Recertificaion for STD amp; TB

340B Drug Pricing Program Forms

OMB: 0915-0327

IC ID: 190351

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Annual Recertificaion for STD amp; TB
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 STD-Recert STD-Recert.pdf Yes Yes Fillable Fileable
Form and Instruction 2 TB-Recertification TB-Recertification.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,754 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,754 0 0 0 0 2,754
Annual IC Time Burden (Hours) 1,377 0 0 0 0 1,377
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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