Hospital Annual Recertification

340B Drug Pricing Program Forms

OMB: 0915-0327

IC ID: 190348

Information Collection (IC) Details

View Information Collection (IC)

Hospital Annual Recertification
 
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 1 Public Ownership-Revised.docx Hospital Recertification-DSH.pdf Yes Yes Fillable Fileable
Form 3 Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf Yes Yes Fillable Fileable
Form 2 Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,134 280
   
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 12,804 0 7,962 0 0 4,842
Annual IC Time Burden (Hours) 3,201 0 780 0 0 2,421
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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