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 Pharmaceutical Pricing Agreement Addendum Form New Available
Form 1 Registrations for STD/TB Clinics Form and Instruction New Available
Form 1 Registrations for Community Health Centers Form and Instruction New Available
Form 1 Manufacturer Data Required to Verify 340 B Ceiling Price Calculations Form Unchanged Available
Form 1 Pharmaceutical Pricing Agreement Form and Instruction Unchanged Available
Form 1 340B Program Registrations and Certifications for Critical Access Hospitals Form Removed Available
Form 1 340B Program Registrations amp; Certifications for Sole Community Hospitals Form Removed Available
Form 1 340B Program Registrations amp; Certifications for Rural Referral Hospitals Form Removed Available
Form 1 340B Program Registrations amp; Certifications for Free Standing Cancer Hospitals Form Removed Available
Form 1 Administrative Changes for Any Manufacturer Form Unchanged Available
Form 1 Contract Pharmacy Registration Form Form Modified Available
Form 1 Administrative Change Form Form and Instruction Unchanged Available
Form 2 Annual Recertification for Other Entities Form Modified Available
Form 1 Annual Recertificaion for STD amp; TB Form Unchanged Available
Form 1 Annual Recertification for Community Health Centers Form Modified Available
Form 1 340B Registration for all other covered entities Form and Instruction Modified Available
Form 2 Hospital Annual Recertification Form Unchanged Available
Form 1 Certification to Enroll Hospitals' Outpatient facilities to 340B Program Form and Instruction Modified Available
Form 1 340B Program Registrations amp; Certifications for Children's Hospitals Form Removed Available
Form 1 340B Program Registrations and Certifications for Hospitals 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 New
221299 Registrations for STD/TB Clinics Form and Instruction New
221298 Registrations for Community Health Centers Form and Instruction New
216088 Manufacturer Data Required to Verify 340 B Ceiling Price Calculations Form Unchanged
203465 Pharmaceutical Pricing Agreement Form and Instruction Unchanged
203464 340B Program Registrations and Certifications for Critical Access Hospitals Form Removed
203463 340B Program Registrations amp; Certifications for Sole Community Hospitals Form Removed
203462 340B Program Registrations amp; Certifications for Rural Referral Hospitals Form Removed
203461 340B Program Registrations amp; Certifications for Free Standing Cancer Hospitals Form Removed
203460 Administrative Changes for Any Manufacturer Form Unchanged
190354 Contract Pharmacy Registration Form Form Modified
190353 Administrative Change Form Form and Instruction Unchanged
190352 Annual Recertification for Other Entities Form Modified
190351 Annual Recertificaion for STD amp; TB Form Unchanged
190350 Annual Recertification for Community Health Centers Form Modified
190349 340B Registration for all other covered entities Form and Instruction Modified
190348 Hospital Annual Recertification Form Unchanged
190347 Certification to Enroll Hospitals' Outpatient facilities to 340B Program Form and Instruction Modified
190346 340B Program Registrations amp; Certifications for Children's Hospitals Form Removed
190345 340B Program Registrations and Certifications for Hospitals Form Modified

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





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table that charts list of burden
IC Title Form No. Form Name
340B Program Registrations amp; Certifications for Sole Community Hospitals 1 340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED
Registrations for STD/TB Clinics 1, 2 340BRegistration-Covered Entities STD-Revised ,   340BRegistration-Covered Entities TB-Revised
340B Program Registrations amp; Certifications for Rural Referral Hospitals 1 340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug)-REVISED
340B Program Registrations and Certifications for Critical Access Hospitals 1 340B Registration-CAH-Revised
Registrations for Community Health Centers 1 340BRegistration-Covered Entities - Community Health Center.docx
Pharmaceutical Pricing Agreement Addendum 1 DRAFT PPA Addendum (FINAL REVISED).docx
Manufacturer Data Required to Verify 340 B Ceiling Price Calculations 1 Manufacturer Data Fields for 340B Ceiling Price - FINAL VERSION
340B Registration for all other covered entities 1 340BRegistration-Covered Entities All Other-Revised
Annual Recertification for Community Health Centers 1 Conmmunity Health Center Recert
Certification to Enroll Hospitals' Outpatient facilities to 340B Program 1 3 340B Registration-Outpatient Facility Revised
Hospital Annual Recertification 2, 3, 1 Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised ,   Public Ownership-Revised.docx ,   Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf
Annual Recertificaion for STD amp; TB 1, 2 STD-Recertification ,   TB-Recertification
Administrative Change Form 1 340B Participant Change Request-Revised
Contract Pharmacy Registration Form 1, 2 Contract Pharmacy Registration-Revised ,   Contract Pharmacy Termination
Annual Recertification for Other Entities 2 RW-Recertification-Revised
340B Program Registrations and Certifications for Hospitals 1, 3, 4, 2, 5, 6, 7 340B Registration DSH-Revised ,   Cert state or local government-Revised.docx ,   Public Ownership-Revised ,   340B Registration Children's Hospital ,   340B Registration Free Standing Cancer ,   340B Registration Rural Referral and Sole Community Hospitals (Orphan Drug) Revised ,   340B Registration-CAH-Revised.docx
Administrative Changes for Any Manufacturer 1 340B Manufacturer Change Form-Revised
Pharmaceutical Pricing Agreement 1 Manufacturer Pharma Pricing Agreement (PPA)
340B Program Registrations amp; Certifications for Children's Hospitals 1, 2, 3 340B Registration Children's Hospital -Revised ,   Cert state or local government-Revised ,   Public Ownership-Revised.docx
340B Program Registrations amp; Certifications for Free Standing Cancer Hospitals 1 340B Registration Free Standing Cancer-Revised

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


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