Information Collection Request

Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 (CMS-367)

ICR 201912-0938-003 · OMB 0938-0578 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-367d Supplemental Data Sheet (CMS-367d) Form Modified Available
CMS-367 - Supporting Statement A (2019 version 3).docx Supporting Statement A Uploaded 2019-12-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8184 DDR Quarterly Pricing Data Specifications (CMS-367a) Instruction Modified
222509 One-Time Cost of Training Drug Manufacturer Staff Removed
222508 One-Time Reconfiguration of Labeler Drug Pricing Systems Removed
222507 Supplemental Data Sheet (CMS-367d) Form Modified
222506 DDR Product Data Specifications (CMS-367c) Instruction Modified
222505 DDR Monthly Pricing Data Specifications (CMS-367b) Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2023 36 Months From Approved 02/29/2020
14,117 0 12,810
536,670 0 3,618,703
0 0 0





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 14,117 12,810 0 2,527 -1,220 0
Annual Time Burden (Hours) 536,670 3,618,703 0 89,967 -3,172,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No