Pharmacy Billing Requirements

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Information Collection (IC) Details

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IC Title:	Pharmacy Billing Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 725.705 20 CFR 30.701 20 CFR 725.701 20 CFR 10.801

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: DOL/GOVT-1 (FECA); DOL/OWCP-6 (BLBA); DOL/OWCP-11 (EEOICPA)	FR Citation: 90 FR 197131

Number of Respondents: 777,528	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: 98 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	777,528	0	-96,886	874,414
Annual IC Time Burden (Hours)	12,994	0	-1,487	14,481
Annual IC Cost Burden (Dollars)	0	-8,296,224	8,296,224	0

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