Information Collection

Pharmaceutical Pricing Agreement Addendum

IC 221302 under ICR 201604-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.