Information Collection Request

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

ICR 202102-0938-016 · OMB 0938-0578 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-376a Quarterly Pricing Data Form Modified Available
Form CMS-376a DDR Quarterly Pricing Data (CMS-367a) Form Modified Repair queued
Form CMS-367d Contact Information Sheet Form Modified Available
Form CMS-367d Supplemental Data Sheet (CMS-367d) Form Modified Repair queued
Form CMS-367c Product Data Form Modified Available
Form CMS-367b Monthly Pricing Data Form Modified Available
CMS-367 - Response to Comments.docx Supplementary Document Uploaded 2021-02-26 Repair queued
CMS-367 - Supporting Statement A (2021 version 1).docx Supporting Statement A Uploaded 2021-02-26 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8184 DDR Quarterly Pricing Data (CMS-367a) Form ModifiedQuarterly Pricing Data
8184 DDR Quarterly Pricing Data (CMS-367a) Form Modified
8184 DDR Quarterly Pricing Data (CMS-367a) Instruction Modified
246017 One-Time System Updates (CMS-367a, b, and c) New
222507 Supplemental Data Sheet (CMS-367d) Form ModifiedContact Information Sheet
222507 Supplemental Data Sheet (CMS-367d) Form Modified
222506 DDR Product Data (CMS-367c) Form ModifiedProduct Data
222506 DDR Product Data (CMS-367c) Instruction Modified
222505 DDR Monthly Pricing Data (CMS-367b) Form ModifiedMonthly Pricing Data
222505 DDR Monthly Pricing Data (CMS-367b) Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2024 36 Months From Approved 02/28/2023
14,980 0 14,117
558,980 0 536,670
0 0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
DDR Monthly Pricing Data (CMS-367b) CMS-367b
DDR Product Data (CMS-367c) CMS-367c
DDR Quarterly Pricing Data (CMS-367a) CMS-376a
One-Time System Updates (CMS-367a, b, and c)
Supplemental Data Sheet (CMS-367d) CMS-367d

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 14,980 14,117 0 749 114 0
Annual Time Burden (Hours) 558,980 536,670 0 17,976 4,334 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No