Information Collection

Submission of Administrative Changes for Any Manufacturer

IC 203460 under ICR 201908-0915-001 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5 Submission of Administrative Changes for Any Manufacturer	Form and Instruction
5 340B Manufacturer Change Form.pdf 340B Manufacturer Change Form..pdf	Form and Instruction
Manufacturer Change Form.docx REDLINE Manufacturer Change Form	IC Document

IC Title:

Submission of Administrative Changes for Any Manufacturer

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:

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	5	340B Manufacturer Change Form.pdf	340B Manufacturer Change Form..pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

Number of Respondents for Small Entity: 120

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
REDLINE Manufacturer Change Form	Manufacturer Change Form.docx	08/12/2019

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