Information Collection

New Burden Estimates Resulting from Policy related Reflect Pharmacy Price Concessions in the Negotiated Price

IC 253715 under ICR 202205-0938-017 · OMB 0938-0982.

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IC Title:	New Burden Estimates Resulting from Policy related Reflect Pharmacy Price Concessions in the Negotiated Price	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.100

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 298	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	298	298
Annual IC Time Burden (Hours)	11,920	11,920
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.