DDR Quarterly Pricing Data (CMS-367a)

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

OMB: 0938-0578

IC ID: 8184

Information Collection (IC) Details

View Information Collection (IC)

DDR Quarterly Pricing Data (CMS-367a)
 
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-376a Quarterly Pricing Data CMS-367a Data Entry Screenshots_09.2021.pdf Yes Yes Fillable Fileable
Instruction CMS-367a Instruction Screenshots_09.2021.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

780 100
   
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 3,120 0 0 124 0 2,996
Annual IC Time Burden (Hours) 108,576 0 0 4,315 0 104,261
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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