Certification to Enroll DSH and Children's Hospitals' Outpatient facilities to 340B Program

340B Drug Pricing Program Forms

OMB: 0915-0327

IC ID: 190347

Information Collection (IC) Details

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Certification to Enroll DSH and Children's Hospitals' Outpatient facilities to 340B Program
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 3 340B Registration-Outpatient Facility Revised 3 340B Registration-Outpatient Facility Revised.docx Yes Yes Fillable Fileable

Health Health Care Services

 

606 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 606 0 0 0 0 606
Annual IC Time Burden (Hours) 303 0 0 0 0 303
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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