DDR Quarterly Pricing Data Specifications (CMS-367a)

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

OMB: 0938-0578

IC ID: 8184

Information Collection (IC) Details

View Information Collection (IC)

DDR Quarterly Pricing Data Specifications (CMS-367a)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-367_Instructions_to_Labelers_August 2019_Final.pdf Yes Yes Fillable Fileable
Form CMS-376a Quarterly Pricing Data 367a_August 2019_Final.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

743 100
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,972 0 532 0 0 2,440
Annual IC Time Burden (Hours) 103,426 0 18,514 0 0 84,912
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-367a - Track Changes 367a_August 2019_Track Changes.docx 12/12/2019
CMS-367a - Crosswalk Form Record Specification Crosswalk 367a_August 2019.xlsx 12/12/2019
Instructions - Crosswalk Form Record Specification Crosswalk of Instructions Document December 2019.xlsx 12/12/2019
Instructions - Track Changes CMS-367_Instructions_to_Labelers_August 2019_Track Changes.docx 12/12/2019
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