Information Collection

DDR Monthly Pricing Data Specifications (CMS-367b)

IC 222505 under ICR 201607-0938-008 · OMB 0938-0578.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0578 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-367 - Instructions to Labelers -CLEAN - updated 4_21_16.docx	Instruction
CMS-367b DDR Monthly Pricing Data Specifications DDR Screenshots for CMS-367a_b_c_CLEAN_updated_7.12.16.docx	Form

IC Title:

DDR Monthly Pricing Data Specifications (CMS-367b)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Instruction			CMS-367 - Instructions to Labelers -CLEAN - updated 4_21_16.docx		Yes	Yes	Fillable Fileable
Form	CMS-367b	DDR Monthly Pricing Data Specifications	DDR Screenshots for CMS-367a_b_c_CLEAN_updated_7.12.16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 610

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,320	7,320
Annual IC Time Burden (Hours)	327,936	327,936
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.