Information Collection Request

Enrollment and Re-Certification of Entities in the 340B Drug Pricing Program and Collection of Manufacturer Data to Verify 340B Drug Pricing Program Ceiling Price Calculations

ICR 201604-0915-002 · OMB 0915-0327 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 DRAFT PPA Addendum (FINAL REVISED).docx Form New Available
Form 2 340BRegistration-Covered Entities TB-Revised Form and Instruction New Available
Form 1 340BRegistration-Covered Entities STD-Revised Form and Instruction New Available
Form 1 340BRegistration-Covered Entities - Community Health Center.docx Form and Instruction New Available
Form 1 Manufacturer Data Fields for 340B Ceiling Price - FINAL VERSION Form Unchanged Available
Form 1 Manufacturer Pharma Pricing Agreement (PPA) Form and Instruction Unchanged Available
Form 1 340B Registration-CAH-Revised Form Removed Available
Form 1 340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED Form Removed Available
Form 1 340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED Form Removed Available
Form 1 340B Registration Free Standing Cancer-Revised Form Removed Available
Form 1 340B Manufacturer Change Form-Revised Form Unchanged Available
Form 2 Contract Pharmacy Termination Form Modified Available
Form 1 Contract Pharmacy Registration-Revised Form Modified Available
Form 1 340B Participant Change Request-Revised Form and Instruction Unchanged Available
Form 2 RW-Recertification-Revised Form Modified Available
Form 2 TB-Recertification Form Unchanged Available
Form 1 STD-Recertification Form Unchanged Available
Form 1 Conmmunity Health Center Recert Form Modified Available
Form 1 340BRegistration-Covered Entities All Other-Revised Form and Instruction Modified Available
Form 3 Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf Form Unchanged Available
Form 1 Public Ownership-Revised.docx Form Unchanged Available
Form 2 Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised Form Unchanged Available
Form 1 3 340B Registration-Outpatient Facility Revised Form and Instruction Modified Available
Form 3 Public Ownership-Revised.docx Form Removed Available
Form 2 Cert state or local government-Revised Form Removed Available
Form 1 340B Registration Children's Hospital -Revised Form Removed Available
Form 7 340B Registration-CAH-Revised.docx Form Modified Available
Form 6 340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug) Revised Form Modified Available
Form 5 340B Registration Free Standing Cancer Form Modified Available
Form 4 340B Registration Children's Hospital Form Modified Available
Form 3 Public Ownership-Revised Form Modified Available
Form 2 Cert state or local government-Revised.docx Form Modified Available
Form 1 340B Registration DSH-Revised Form Modified Available
List of all ICR documents REVISED.docx Supplementary Document Uploaded 2016-04-29 Available
60-day FRN.pdf Supplementary Document Uploaded 2016-04-29 Available
30 day FRN.pdf Supplementary Document Uploaded 2016-04-29 Available
FINALRevised0327Supporting Statement A (PPA Addendum Revision) 04192016 TRAC....docx Supporting Statement A Uploaded 2016-04-29 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
221302 Pharmaceutical Pricing Agreement Addendum Form NewDRAFT PPA Addendum (FINAL REVISED).docx
221302 Pharmaceutical Pricing Agreement Addendum Instruction New
221299 Registrations for STD/TB Clinics Form and Instruction New340BRegistration-Covered Entities TB-Revised
221299 Registrations for STD/TB Clinics Form and Instruction New340BRegistration-Covered Entities STD-Revised
221298 Registrations for Community Health Centers Form and Instruction New340BRegistration-Covered Entities - Community Health Center.docx
216088 Manufacturer Data Required to Verify 340 B Ceiling Price Calculations Form UnchangedManufacturer Data Fields for 340B Ceiling Price - FINAL VERSION
203465 Pharmaceutical Pricing Agreement Form and Instruction UnchangedManufacturer Pharma Pricing Agreement (PPA)
203464 340B Program Registrations and Certifications for Critical Access Hospitals Form Removed340B Registration-CAH-Revised
203463 340B Program Registrations amp; Certifications for Sole Community Hospitals Form Removed340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED
203462 340B Program Registrations amp; Certifications for Rural Referral Hospitals Form Removed340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED
203461 340B Program Registrations amp; Certifications for Free Standing Cancer Hospitals Form Removed340B Registration Free Standing Cancer-Revised
203460 Administrative Changes for Any Manufacturer Form Unchanged340B Manufacturer Change Form-Revised
190354 Contract Pharmacy Registration Form Form ModifiedContract Pharmacy Termination
190354 Contract Pharmacy Registration Form Form ModifiedContract Pharmacy Registration-Revised
190353 Administrative Change Form Form and Instruction Unchanged340B Participant Change Request-Revised
190352 Annual Recertification for Other Entities Form ModifiedRW-Recertification-Revised
190351 Annual Recertificaion for STD amp; TB Form UnchangedTB-Recertification
190351 Annual Recertificaion for STD amp; TB Form UnchangedSTD-Recertification
190350 Annual Recertification for Community Health Centers Form ModifiedConmmunity Health Center Recert
190349 340B Registration for all other covered entities Form and Instruction Modified340BRegistration-Covered Entities All Other-Revised
190348 Hospital Annual Recertification Form UnchangedRecert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf
190348 Hospital Annual Recertification Form UnchangedPublic Ownership-Revised.docx
190348 Hospital Annual Recertification Form UnchangedRecert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised
190347 Certification to Enroll Hospitals' Outpatient facilities to 340B Program Form and Instruction Modified3 340B Registration-Outpatient Facility Revised
190346 340B Program Registrations amp; Certifications for Children's Hospitals Form RemovedPublic Ownership-Revised.docx
190346 340B Program Registrations amp; Certifications for Children's Hospitals Form RemovedCert state or local government-Revised
190346 340B Program Registrations amp; Certifications for Children's Hospitals Form Removed340B Registration Children's Hospital -Revised
190345 340B Program Registrations and Certifications for Hospitals Form Modified340B Registration-CAH-Revised.docx
190345 340B Program Registrations and Certifications for Hospitals Form Modified340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug) Revised
190345 340B Program Registrations and Certifications for Hospitals Form Modified340B Registration Free Standing Cancer
190345 340B Program Registrations and Certifications for Hospitals Form Modified340B Registration Children's Hospital
190345 340B Program Registrations and Certifications for Hospitals Form ModifiedPublic Ownership-Revised
190345 340B Program Registrations and Certifications for Hospitals Form ModifiedCert state or local government-Revised.docx
190345 340B Program Registrations and Certifications for Hospitals Form Modified340B Registration DSH-Revised

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2019 36 Months From Approved 09/30/2018
56,705 0 52,591
27,594 0 27,054
0 0 0





Reginfo record details
15
table that charts list of burden
IC Title Form No. Form Name
340B Program Registrations amp; Certifications for Children's Hospitals 1, 2, 3 ,   ,  
340B Program Registrations amp; Certifications for Free Standing Cancer Hospitals 1
340B Program Registrations amp; Certifications for Rural Referral Hospitals 1
340B Program Registrations amp; Certifications for Sole Community Hospitals 1
340B Program Registrations and Certifications for Critical Access Hospitals 1
340B Program Registrations and Certifications for Hospitals 1, 3, 4, 2, 5, 6, 7 ,   ,   ,   ,   ,   ,  
340B Registration for all other covered entities 1
Administrative Change Form 1
Administrative Changes for Any Manufacturer 1
Annual Recertificaion for STD amp; TB 1, 2 ,  
Annual Recertification for Community Health Centers 1
Annual Recertification for Other Entities 2
Certification to Enroll Hospitals' Outpatient facilities to 340B Program 1
Contract Pharmacy Registration Form 1, 2 ,  
Hospital Annual Recertification 2, 3, 1 ,   ,  
Manufacturer Data Required to Verify 340 B Ceiling Price Calculations 1
Pharmaceutical Pricing Agreement 1
Pharmaceutical Pricing Agreement Addendum 1
Registrations for Community Health Centers 1
Registrations for STD/TB Clinics 1, 2 ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 56,705 52,591 0 4,264 -150 0
Annual Time Burden (Hours) 27,594 27,054 0 840 -300 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No