DDR Monthly Pricing Data (CMS-367b)

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.