340B Program Registrations amp; Certifications for Children's Hospitals

340B Drug Pricing Program Forms

OMB: 0915-0327

IC ID: 190346

Information Collection (IC) Details

View Information Collection (IC)

340B Program Registrations amp; Certifications for Children's Hospitals
 
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 3 Public Ownership-Revised.docx Public Ownership-Revised.docx Yes Yes Fillable Fileable
Form 1 340B Registration Children's Hospital -Revised 340B Registration Children's Hospital -Revised.docx Yes Yes Fillable Fileable
Form 2 Cert state or local government-Revised Cert state or local government-Revised.docx Yes Yes Fillable Fileable

Health Health Care Services

 

30 0
   
Private Sector 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 30 0 18 0 0 12
Annual IC Time Burden (Hours) 60 0 36 0 0 24
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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