DDR Quarterly Pricing Data (CMS-367a)

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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-376a DDR Quarterly Pricing Data (CMS-367a) Form
CMS-367a - Screenshots of MDP Web-Based Instructions_07.2021_508.pdf Instruction
CMS-367a - Screenshots of MDP Web-Based Instructions_07.2021_508.pdf Instruction
CMS-376a Quarterly Pricing Data CMS-367a - Screenshots of MDP Online Data Entry_07.2021_508.pdf Form
CMS-376a Quarterly Pricing Data CMS-367a - Screenshots of MDP Online Data Entry_07.2021_508.pdf Form
CMS Form-367a_Quarterly Pricing_Crosswalk_07.2021_508.pdf Crosswalk - CMS-367a IC Document
CMS Form-367a_Quarterly Pricing_Crosswalk_07.2021_508.pdf Crosswalk - CMS-367a IC Document

Information Collection (IC) Details

IC Title:	DDR Quarterly Pricing Data (CMS-367a)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-376a	Quarterly Pricing Data	CMS-367a - Screenshots of MDP Online Data Entry_07.2021_508.pdf		Yes	Yes	Fillable Fileable
Instruction			CMS-367a - Screenshots of MDP Web-Based Instructions_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: 100

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	2,996	24	2,972
Annual IC Time Burden (Hours)	104,261	835	103,426
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk - CMS-367a	CMS Form-367a_Quarterly 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.