DDR Product Data (CMS-367c)

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

Documents and Forms

Document Name Document Type
CMS-367c Instruction Screenshots_09.2021.pdf Instruction
CMS-367c Instruction Screenshots_09.2021.pdf Instruction
CMS-367c Product Data CMS-367c Data Entry Screenshots_09.2021.pdf Form
CMS-367c Product Data CMS-367c Data Entry Screenshots_09.2021.pdf Form

Information Collection (IC) Details

IC Title:	DDR Product Data (CMS-367c)	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-367c Instruction Screenshots_09.2021.pdf		Yes	Yes	Fillable Fileable
Form	CMS-367c	Product Data	CMS-367c Data Entry Screenshots_09.2021.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 818	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	818	38	780
Annual IC Time Burden (Hours)	35,583	1,653	33,930
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.