Information Collection Request

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

ICR 202203-0938-002 · OMB 0938-0578 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-376a Quarterly Pricing Data Form Modified Repair queued
Form CMS-376a DDR Quarterly Pricing Data (CMS-367a) Form Modified Repair queued
Form CMS-367e Quarterly VBP-MBP Data Form New Repair queued
Form CMS-367e CMS-367e – Quarterly VBP-MBP Data Form New 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-367a-e - Supporting Statement A (2022 version 3).docx Supporting Statement A Uploaded 2022-03-21 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
252237 CMS-367e – System Updates New
252230 CMS-367e – Quarterly VBP-MBP Data Form NewQuarterly VBP-MBP Data
252230 CMS-367e – Quarterly VBP-MBP Data Form New
252230 CMS-367e – Quarterly VBP-MBP Data Instruction New
246017 One-Time System Updates (CMS-367a, b, and c) Removed
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
09/30/2025 36 Months From Approved 05/31/2024
15,070 0 14,980
564,394 0 558,980
0 0 0





Reginfo record details
6
table that charts list of burden
IC Title Form No. Form Name
CMS-367e – Quarterly VBP-MBP Data CMS-367e
CMS-367e – System Updates
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 15,070 14,980 0 250 -160 0
Annual Time Burden (Hours) 564,394 558,980 0 1,000 4,414 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No