Information Collection

340B Program Registrations amp; Certifications for Rural Referral Hospitals

IC 203462 under ICR 201504-0915-001 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material.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 Program Registrations amp; Certifications for Rural Referral Hospitals Form
1 340B Registration Rural Referral and Sole Community Hosp 340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	340B Program Registrations amp; Certifications for Rural Referral 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED	340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-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: 15

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	48
Annual IC Time Burden (Hours)	60	-36	96
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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