Information Collection

DDR Quarterly Pricing Data Specifications (CMS-367a)

IC 8184 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form CMS-367a DDR Quarterly Pricing Data Specifications (CMS-367a) Form
CMS-367 - Instructions to Labelers -CLEAN - updated 4_21_16.docx Instruction
CMS-367a DDR Quarterly Pricing Data Specifications DDR Screenshots for CMS-367a_b_c_CLEAN_updated_7.12.16.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DDR Quarterly Pricing Data Specifications (CMS-367a)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	CMS-367a	DDR Quarterly Pricing Data Specifications	DDR Screenshots for CMS-367a_b_c_CLEAN_updated_7.12.16.docx		Yes	Yes	Fillable Fileable
Instruction			CMS-367 - Instructions to Labelers -CLEAN - updated 4_21_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: 100

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,440	-10,370	12,810
Annual IC Time Burden (Hours)	84,912	-3,527,691	3,612,603
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.