Information Collection

Pharmacy SOPS Registration Form

IC 211034 under ICR 201702-0935-001 · OMB 0935-0218.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Pharmacy SOPS Registration Form	Form and Instruction
1 Pharmacy SOPS Registration Form Attachment A - Pharmacy Eligibility and Registration Form_updated 6-13-17_clean.docx	Form and Instruction
Attachment H - Example Screenshots of Pharmacy SOPS Data Submission Web Site.docx Attachment H: Example Screen Shots of Pharmacy SOPS Data Submission Web Site	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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 and Instruction	1	Pharmacy SOPS Registration Form	Attachment A - Pharmacy Eligibility and Registration Form_updated 6-13-17_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	Previously Approved
Annual Number of Responses for this IC	100	-50	150
Annual IC Time Burden (Hours)	8	-5	13
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment H: Example Screen Shots of Pharmacy SOPS Data Submission Web Site	Attachment H - Example Screenshots of Pharmacy SOPS Data Submission Web Site.docx	02/27/2017

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