Information Collection Request

Enrollment and Re-Certification of Entities in the 340B Drug Pricing Program and Collection of Manufacturer Data to Verify 340B Drug Pricing Program Ceiling Price Calculations

ICR 201908-0915-001 · OMB 0915-0327 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 6 Pharmaceutical Pricing Agreement and PPA Addendum Form and Instruction Modified Available
Form 1 Registrations for STD/TB Clinics Form and Instruction Removed Available
Form 1 Registrations for Community Health Centers Form and Instruction Removed Available
Form 7 Manufacturer Data Required to Verify 340 B Ceiling Price Form Modified Available
Form 1 Pharmaceutical Pricing Agreement Form and Instruction Removed Available
Form 5 Submission of Administrative Changes for Any Manufacturer Form and Instruction Modified Available
Form 1 Contract Pharmacy Registration Form Form Removed Available
Form 4 Submission of Administrative Changes for any Covered Entities Form Modified Available
Form 2 Annual Recertification for Other Entities Form Removed Available
Form 1 Annual Recertificaion for STD amp; TB Form Removed Available
Form 1 Annual Recertification for Community Health Centers Form Removed Available
Form 1 340B Registration for all other covered entities Form and Instruction Removed Available
Form 3.1 Contracted Pharmacy Services Registration and Recertifications Form Modified Available
Form 2.1 Registrations and Recertifications for Entities other than Hospitals Form and Instruction Modified Available
Form 1.1 Hospital Enrollment, Additions and Recertifcations Form Modified Available
Supporting Statement A.docx Supporting Statement A Uploaded 2019-08-05 Available
0327 60 Day FRN.pdf Supplementary Document Uploaded 2019-08-05 Available

IC Document Collections

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2022 36 Months From Approved 11/30/2019
94,629 0 56,705
44,660 0 27,594
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
Registrations for Community Health Centers 1 340BRegistration-Covered Entities - Community Health Center.docx
Annual Recertification for Community Health Centers 1 Conmmunity Health Center Recert
Registrations for STD/TB Clinics 1, 2 340BRegistration-Covered Entities STD-Revised ,   340BRegistration-Covered Entities TB-Revised
Annual Recertificaion for STD amp; TB 1, 2 STD-Recertification ,   TB-Recertification
Annual Recertification for Other Entities 2 RW-Recertification-Revised
Pharmaceutical Pricing Agreement 1 Manufacturer Pharma Pricing Agreement (PPA)
Contracted Pharmacy Services Registration and Recertifications 3.2, 3.1 Contract Pharmacy Registration.pdf ,   Contract Pharmacy Termination.pdf
Submission of Administrative Changes for any Covered Entities 4 340B Covered Entity Change Request.pdf
Hospital Enrollment, Additions and Recertifcations 1.1, 1.2, 1.4, 1.5, 1.3, 1.6, 1.10, 1.11, 1.8, 1.7, 1.9 340B Registration DSH Parent.pdf ,   340B Registration Children's Hospital PED Parent.pdf ,   340B Registration CAN Parent.pdf ,   340B Registration Hospital Outpatient Facility.pdf ,   340B Registration RRC and SCH Parent.pdf ,   340B Registration CAH Parent.pdf ,   340B Recertification DSH.pdf ,   340B Recertification SCH and RRC.pdf ,   340B Recertification PED.pdf ,   340B Recertification CAH.pdf ,   340B Recertification CAN.pdf
Submission of Administrative Changes for Any Manufacturer 5 340B Manufacturer Change Form.pdf
340B Registration for all other covered entities 1 340BRegistration-Covered Entities All Other-Revised
Contract Pharmacy Registration Form 1, 2 Contract Pharmacy Registration-Revised ,   Contract Pharmacy Termination
Pharmaceutical Pricing Agreement and PPA Addendum 6 Manufacturer PPA and addendum.pdf
Manufacturer Data Required to Verify 340 B Ceiling Price 7 Manufacturer Data Fields for 340B Ceiling Price.pdf
Registrations and Recertifications for Entities other than Hospitals 2.1, 2.2, 2.3, 2.4, 2.5, 2.6 340B Registration CHC and FQHCLA.pdf ,   340B Registration STD and TB.pdf ,   340B Registration-Covered Entities All Other Non-Hospitals.pdf ,   340B Recertfication STD and TB.pdf ,   340B Recertification CHC and FQHCLA.pdf ,   340B Recertification Covered Entities All Other Non-Hospital..pdf

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 94,629 56,705 0 63,289 -25,365 0
Annual Time Burden (Hours) 44,660 27,594 0 31,900 -14,834 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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