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Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 (CMS-367)

IC 8184 under ICR 201603-0938-012 · OMB 0938-0578.

Documents and Forms
Document Name
Document Type
Other-PRA Disclosure Statement
Instruction
Other-Correction to PRA Disclosure S
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 (CMS-367)
 
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
Other-Correction to PRA Disclosure Statement CORRECTION PRA Disclosure Statement for CMS-367a b and c.docx No   Printable Only
Form CMS-367a, CMS-367b, and CMS-367c Medicaid Drug Program Monthly and Quarterly Drug Reporting DDR Screenshots for CMS-367a_b_c_3.18.16.docx Yes Yes Fillable Printable
Instruction CMS-367 - Instructions to Labelers -CLEAN - updated.3 25 16.docx Yes No Printable Only
Other-PRA Disclosure Statement CMS-367 -Disclosure Statement -CLEAN 3.25.16.docx No   Printable Only
Form CMS-367d Supplemental Data Sheet Form367(d)updated.pdf Yes Yes Fillable Printable

Health Health Care Services

 

610 100
   
Private Sector Businesses or other for-profits
 
   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 12,810 2,440 0 0 0 10,370
Annual IC Time Burden (Hours) 3,612,603 3,456,260 0 0 0 156,343
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk - Record Specification Form Record Specification Crosswalk - 3 16 16.xlsx 03/18/2016
Crosswalk - Instructions Instructions for Labelers Crosswalk 3 16 16.xlsx 03/18/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.