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

340B Drug Pricing Program Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

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

Information Collection (IC) Details

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	18	12
Annual IC Time Burden (Hours)	60	36	24
Annual IC Cost Burden (Dollars)	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.