Information Collection Request

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

ICR 201607-0938-008 · OMB 0938-0578 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-367a DDR Quarterly Pricing Data Specifications (CMS-367a) Form Modified Available
Form CMS-367d Supplemental Data Sheet (CMS-367d) Form New Available
CMS-367 - Supporting Statement A [rev 07-17-2016 by OSORA PRA].docx Supporting Statement A Uploaded 2016-07-17 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2019 36 Months From Approved 03/31/2019
12,810 0 12,810
3,618,703 0 3,612,603
0 0 0





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 12,810 12,810 0 0 0 0
Annual Time Burden (Hours) 3,618,703 3,612,603 0 6,100 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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