Information Collection Request

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

ICR 202304-0938-029 · OMB 0938-0578 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-376a Quarterly Pricing Data Form Modified Available
Form CMS-376a DDR Quarterly Pricing Data (CMS-367a) Form Modified Repair queued
Form CMS-367e Quarterly VBP-MBP Data Form Unchanged Available
Form CMS-367e CMS-367e – Quarterly VBP-MBP Data Form Unchanged 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 (2023 version 5).docx Supporting Statement A Uploaded 2023-05-03 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 Removed
252230 CMS-367e – Quarterly VBP-MBP Data Form UnchangedQuarterly VBP-MBP Data
252230 CMS-367e – Quarterly VBP-MBP Data Form Unchanged
252230 CMS-367e – Quarterly VBP-MBP Data Instruction Unchanged
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
06/30/2026 36 Months From Approved 09/30/2025
15,742 0 15,070
591,042 0 564,394
0 0 0





Reginfo record details
5
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
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 15,742 15,070 0 722 -50 0
Annual Time Burden (Hours) 591,042 564,394 0 27,448 -800 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No