Supplemental Data Sheet (CMS-367d)

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

OMB: 0938-0578

IC ID: 222507

Information Collection (IC) Details

View Information Collection (IC)

Supplemental Data Sheet (CMS-367d)
 
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
Form CMS-367d Contact Information Sheet CMS Form-367d_Manufacturer Contact Form_07.2021_508.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

749 0
   
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 1,498 0 0 12 0 1,486
Annual IC Time Burden (Hours) 1,498 0 0 12 0 1,486
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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