340B Drug Pricing Program Forms

ICR 201504-0915-001

OMB: 0915-0327

Federal Form Document

Forms and Documents
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Supplementary Document
2015-04-27
Supplementary Document
2015-04-27
Supplementary Document
2015-04-27
Supporting Statement A
2015-09-21
ICR Details
0915-0327 201504-0915-001
Historical Active 201308-0915-006
HHS/HSA 20345
340B Drug Pricing Program Forms
Revision of a currently approved collection   No
Regular
Approved without change 09/28/2015
Retrieve Notice of Action (NOA) 05/01/2015
  Inventory as of this Action Requested Previously Approved
09/30/2018 36 Months From Approved 10/31/2015
52,591 0 24,464
27,054 0 14,705
0 0 0

HRSA Office of Pharmacy Affairs (OPA) has a process for registering covered entities who choose to participate in the section 340B Drug Pricing Program. These entities must comply with the requirements of 340B (a)(5)(A) of the PHS Act. The 340B Drug Pricing Program forms allow entities to provide registration and certifying information and to determine eligibility for the progam.

PL: Pub.L. 102 - 585 601-603 Name of Law: Veterans Health Care Act of 1992
   US Code: 42 USC 340B Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 7101 Name of Law: Patient Protection and Affordable Care Act
  
None

Not associated with rulemaking

  79 FR 58791 09/30/2014
80 FR 22208 04/21/2015
Yes

17
IC Title Form No. Form Name
Manufacturer Data Required to Verify 340 B Ceiling Price Calculations 1 Manufacturer Data Fields for 340B Ceiling Price - FINAL VERSION
340B Registration for all other covered entities 2, 1, 3, 4 340BRegistration-Covered Entities - Community Health Center ,   340BRegistration-Covered Entities All Other-Revised ,   340BRegistration-Covered Entities STD-Revised ,   340BRegistration-Covered Entities TB-Revised
Annual Recertification for Family Planning 1 FP-Recert
Certification to Enroll DSH and Children's Hospitals' Outpatient facilities to 340B Program 1 3 340B Registration-Outpatient Facility Revised
Hospital Annual Recertification 2, 3, 1 Public Ownership-Revised.docx ,   Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf ,   Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised
Annual Recertificaion for STD amp; TB 1, 2 STD-Recertification ,   TB-Recertification
Administrative Change Form 1 340B Participant Change Request-Revised
Contract Pharmacy Self Certification Form 1, 2 Contract Pharmacy Registration-Revised ,   Contract Pharmacy Termination
Annual Recertification for Other Entities 2, 1 RW-Recertification-Revised ,   Conmmunity Health Center Recert
340B Program Registrations amp; Certifications for Children's Hospitals 1, 2, 3 Public Ownership-Revised.docx ,   340B Registration Children's Hospital -Revised ,   Cert state or local government-Revised
340B Program Registrations amp; Certifications for Disproportionate Share Hospitals 1, 3, 2 340B Registration DSH-Revised ,   Public Ownership-Revised ,   Cert state or local government-Revised.docx
Administrative Changes for Any Manufacturer 1 340B Manufacturer Change Form-Revised
340B Program Registrations amp; Certifications for Free Standing Cancer Hospitals 1 340B Registration Free Standing Cancer-Revised
340B Program Registrations amp; Certifications for Rural Referral Hospitals 1 340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED
340B Program Registrations amp; Certifications for Sole Community Hospitals 1 340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED
340B Program Registrations and Certifications for Critical Access Hospitals 1 340B Registration-CAH-Revised
Pharmaceutical Pricing Agreement 1 Manufacturer Pharma Pricing Agreement (PPA)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 52,591 24,464 0 28,127 0 0
Annual Time Burden (Hours) 27,054 14,705 0 12,349 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
Yes
Changing Forms
Currently, there are 14,704 total reporting and record keeping burden hours in the OMB inventory. HRSA is requesting 27,483.5 burden hours, an increase of 12,779.5 hours. The increase is associated in part with the implementation of manufacturer data collection provisions of section 340B of the Public Health Service Act that were amended by section 7102 of the Affordable Care Act, enabling the Secretary to verify the accuracy of ceiling prices calculated by manufacturers and charged to covered entities by comparing them with ceiling prices calculated by the Secretary. In order to perform the comparison, HRSA must require manufacturers to submit the quarterly pricing data containing the average manufacturer price, unit rebate amount, package sizes, National Drug Code, and the manufacturer-determined 340B ceiling prices. The anticipated burden has also increased due to updates made to the estimated number of covered entity respondents and responses per respondent based on 2014 registration and recertification data; we have additionally modified the way respondents and responses are counted to more accurately reflect the number of organizations registering for the program and the number of locations registered by each of those organizations.

$3,751,617
No
No
Yes
No
No
Uncollected
Kaytura Felix 301 871-3052 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/01/2015


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