Information Collection

DDR Monthly Pricing Data (CMS-367b)

IC 222505 under ICR 202102-0938-016 · OMB 0938-0578.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0578 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-367b - Screenshots of MDP Web-Based Instructions_07.2021_508.pdf	Instruction
CMS-367b - Screenshots of MDP Web-Based Instructions_07.2021_508.pdf	Instruction
CMS-367b Monthly Pricing Data CMS-367b - Screenshots of MDP Online Data Entry_07.2021_508.pdf	Form
CMS-367b Monthly Pricing Data CMS-367b - Screenshots of MDP Online Data Entry_07.2021_508.pdf	Form
CMS Form-367b_Monthly Pricing_Crosswalk_07.2021_508.pdf CMS-367b - Crosswalk	IC Document
CMS Form-367b_Monthly Pricing_Crosswalk_07.2021_508.pdf CMS-367b - Crosswalk	IC Document

IC Title:

DDR Monthly Pricing Data (CMS-367b)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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
Instruction			CMS-367b - Screenshots of MDP Web-Based Instructions_07.2021_508.pdf		Yes	Yes	Fillable Fileable
Form	CMS-367b	Monthly Pricing Data	CMS-367b - Screenshots of MDP Online Data Entry_07.2021_508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 749

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,988	72	8,916
Annual IC Time Burden (Hours)	402,663	3,226	399,437
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-367b - Crosswalk	CMS Form-367b_Monthly Pricing_Crosswalk_07.2021_508.pdf	02/26/2021

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