ADR Submission

340B Drug Pricing Program; Initiation of the Administrative Dispute Resolution Process

Documents and Forms

Document Name Document Type
OPAIS ADR submission slides .pdf Instruction
Burden Statement to include in OPAIS.docx Burden Statement to Include in OPAIS IC Document

Information Collection (IC) Details

IC Title:	ADR Submission	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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			OPAIS ADR submission slides .pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	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: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Statement to Include in OPAIS	Burden Statement to include in OPAIS.docx	01/16/2025

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