Pharmaceutical Pricing Agreement Addendum

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

⚠️ Notice: This information collection may be referencing outdated material.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 Pharmaceutical Pricing Agreement Addendum Form
DRAFT PPA Addendum Instructions (FINAL REVISED).docx Instruction
1 DRAFT PPA Addendum (FINAL REVISED).docx DRAFT PPA Addendum (FINAL REVISED).docx Form

Information Collection (IC) Details

IC Title:	Pharmaceutical Pricing Agreement Addendum	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	DRAFT PPA Addendum (FINAL REVISED).docx	DRAFT PPA Addendum (FINAL REVISED).docx		Yes	No	Fillable Printable
Instruction			DRAFT PPA Addendum Instructions (FINAL REVISED).docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 620	Number of Respondents for Small Entity: 70

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	620	620
Annual IC Time Burden (Hours)	310	310
Annual IC Cost Burden (Dollars)	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.