Information Collection

Hospital Enrollment, Additions and Recertifcations

IC 190345 under ICR 202208-0915-001 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

2026-01-12 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1.1 Hospital Enrollment, Additions and Recertifcations	Form
1.1 340B Registration DSH Parent.pdf 340B Registration DSH Parent.pdf	Form
1.1 340B Registration DSH Parent.pdf 340B Registration DSH Parent.pdf	Form
1.2 340B Registration Children's Hospital.pdf 340B Registration Children's Hospital.pdf	Form
1.2 340B Registration Children's Hospital.pdf 340B Registration Children's Hospital.pdf	Form
1.3 340B Registration CAN Parent.pdf 340B Registration Free Standing Cancer.pdf	Form
1.3 340B Registration CAN Parent.pdf 340B Registration Free Standing Cancer.pdf	Form
1.4 340B Registration Hospital Outpatient Facility.pdf 340B Registration- Outpatient Facility.pdf	Form
1.4 340B Registration Hospital Outpatient Facility.pdf 340B Registration- Outpatient Facility.pdf	Form
1.5 340B Registration RRC and SCH Parent.pdf 340B Registration Rural Referral and Sole Community Hospitals.pdf	Form
1.5 340B Registration RRC and SCH Parent.pdf 340B Registration Rural Referral and Sole Community Hospitals.pdf	Form
1.6 340B Registration CAH Parent.pdf 340B Registration-CAH.pdf	Form
1.6 340B Registration CAH Parent.pdf 340B Registration-CAH.pdf	Form
1.7 340B Recertification DSH.pdf 340B Registration DSH Parent.pdf	Form
1.7 340B Recertification DSH.pdf 340B Registration DSH Parent.pdf	Form
1.8 340B Recertification SCH and RRC.pdf 340B Registration Rural Referral and Sole Community Hospitals.pdf	Form
1.8 340B Recertification SCH and RRC.pdf 340B Registration Rural Referral and Sole Community Hospitals.pdf	Form
1.9 340B Recertification Childrens Hospital.pdf 340B Registration Children's Hospital.pdf	Form
1.9 340B Recertification Childrens Hospital.pdf 340B Registration Children's Hospital.pdf	Form
1.10 340B Recertification CAH.pdf 340B Registration-CAH.pdf	Form
1.10 340B Recertification CAH.pdf 340B Registration-CAH.pdf	Form
1.11 340B Recertification CAN.pdf 340B Registration Free Standing Cancer.pdf	Form
1.11 340B Recertification CAN.pdf 340B Registration Free Standing Cancer.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Hospital Enrollment, Additions and Recertifcations

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1.1	340B Registration DSH Parent.pdf	340B Registration DSH Parent.pdf	Yes	Yes	Fillable Fileable
Form	1.2	340B Registration Children's Hospital.pdf	340B Registration Children's Hospital.pdf	Yes	Yes	Fillable Fileable
Form	1.3	340B Registration CAN Parent.pdf	340B Registration Free Standing Cancer.pdf	Yes	Yes	Fillable Fileable
Form	1.4	340B Registration Hospital Outpatient Facility.pdf	340B Registration- Outpatient Facility.pdf	Yes	Yes	Fillable Fileable
Form	1.5	340B Registration RRC and SCH Parent.pdf	340B Registration Rural Referral and Sole Community Hospitals.pdf	Yes	Yes	Fillable Fileable
Form	1.6	340B Registration CAH Parent.pdf	340B Registration-CAH.pdf	Yes	Yes	Fillable Fileable
Form	1.7	340B Recertification DSH.pdf	340B Registration DSH Parent.pdf	Yes	Yes	Fillable Fileable
Form	1.8	340B Recertification SCH and RRC.pdf	340B Registration Rural Referral and Sole Community Hospitals.pdf	Yes	Yes	Fillable Fileable
Form	1.9	340B Recertification Childrens Hospital.pdf	340B Registration Children's Hospital.pdf	Yes	Yes	Fillable Fileable
Form	1.10	340B Recertification CAH.pdf	340B Registration-CAH.pdf	Yes	Yes	Fillable Fileable
Form	1.11	340B Recertification CAN.pdf	340B Registration Free Standing Cancer.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,369

Number of Respondents for Small Entity: 15

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30,651	273	30,378
Annual IC Time Burden (Hours)	8,977	-381	9,358
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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