Information Collection

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

IC 8184 under ICR 201308-0938-021 · OMB 0938-0578.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-367 disclosure statement.doc	Other-Disclosure Statement
CMS-367_Instructions_to_Labelers 2013.docx	Instruction
CMS-367a, -367b, - Medicaid Drug Program Monthly and Quarterly Drug Reporti 367 for omb 2013.pdf	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Disclosure Statement			CMS-367 disclosure statement.doc	Yes	No	Printable Only
Instruction			CMS-367_Instructions_to_Labelers 2013.docx	Yes	No	Printable Only
Form	CMS-367a, -367b, -367c, and -367d	Medicaid Drug Program Monthly and Quarterly Drug Reporting Format	367 for omb 2013.pdf	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 590

Number of Respondents for Small Entity: 100

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9,440	160	9,280
Annual IC Time Burden (Hours)	139,712	2,368	137,344
Annual IC Cost Burden (Dollars)	0	-8,240,640	8,240,640

Documents for IC

table that charts IC Documents
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.