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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)
OMB: 0938-0578
IC ID: 8184
OMB.report
HHS/CMS
OMB 0938-0578
ICR 201309-0938-031
IC 8184
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0578 can be found here:
2023-05-03 - Revision of a currently approved collection
2022-03-21 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
367 disclosure statement.doc
Other-PRA Discolosure Statement
CMS-367 Instructions to Labelers.doc
Instruction
CMS-367a, 367b, 36 CMS Record Specification and Rebate Agreement
CMS-367 Record File Layout.doc
Form
Information Collection (IC) Details
View Information Collection (IC)
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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-PRA Discolosure Statement
367 disclosure statement.doc
Yes
No
Printable Only
Instruction
CMS-367 Instructions to Labelers.doc
Yes
No
Printable Only
Form
CMS-367a, 367b, 367c, and 367d
CMS Record Specification and Rebate Agreement
CMS-367 Record File Layout.doc
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
600
Number of Respondents for Small Entity:
100
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
14,024
4,424
0
160
0
9,440
Annual IC Time Burden (Hours)
775,591
633,511
0
2,368
0
139,712
Annual IC Cost Burden (Dollars)
0
0
0
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.