Information Collection

PBMs

IC 250669 under ICR 202404-0938-028 · OMB 0938-1407.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1407 can be found here:

Documents and Forms

Document Name Document Type
RxDC Reporting Instructions for 2023rev.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PBMs	Agency IC Tracking Number:	CCIIO - 10788

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 149.730 45 CFR 149.720 45 CFR 149.740

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			RxDC Reporting Instructions for 2023rev.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	Previously Approved
Annual Number of Responses for this IC	30	0	30
Annual IC Time Burden (Hours)	62,964	-148,500	211,464
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.