340B Registration for all other covered entities

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⚠️ Notice: This information collection may be referencing outdated material.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 1 340B Registration for all other covered entities Form and Instruction
1 340BRegistration-Covered Entities - Community Health Cen 340BRegistration-Covered Entities - Community Health Center.docx Form and Instruction
2 340BRegistration-Covered Entities All Other-Revised 340BRegistration-Covered Entities All Other-Revised.docx Form and Instruction
3 340BRegistration-Covered Entities STD-Revised 340BRegistration-Covered Entities STD-Revised.docx Form and Instruction
4 340BRegistration-Covered Entities TB-Revised 340BRegistration-Covered Entities TB-Revised.docx Form and Instruction

Information Collection (IC) Details

IC Title:	340B Registration for all other covered entities	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 and Instruction	1	340BRegistration-Covered Entities - Community Health Center	340BRegistration-Covered Entities - Community Health Center.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	340BRegistration-Covered Entities All Other-Revised	340BRegistration-Covered Entities All Other-Revised.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	340BRegistration-Covered Entities STD-Revised	340BRegistration-Covered Entities STD-Revised.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	340BRegistration-Covered Entities TB-Revised	340BRegistration-Covered Entities TB-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: 1,479	Number of Respondents for Small Entity: 150

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,958	2,352	606
Annual IC Time Burden (Hours)	2,958	2,352	606
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.