Information Collection

Voluntary 340B Repository Data Element Reporting Requirements

IC 276684 under ICR 202507-0938-024 · OMB 0938-1485.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1485 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10930 Voluntary 340B Repository Data Element Reporting Requirements Form
Appendix A _340B Data Elements Instruction_OSORA 508 Copy.pdf Instruction
Appendix A _340B Data Elements Instruction_OSORA 508 Copy.pdf Instruction
PRA Disclosure Statement_Inflation Rebate ICR.docx Other-PRA Disclosure Statement
PRA Disclosure Statement_Inflation Rebate ICR.docx Other-PRA Disclosure Statement
CMS-10930 340B Repository Data Element Reporting Form Appendix A_ 340B Repository Data Elements Collection Form_OSORA Copy Clean_07.09.25.xlsx Form
CMS-10930 340B Repository Data Element Reporting Form Appendix A_ 340B Repository Data Elements Collection Form_OSORA Copy Clean_07.09.25.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Voluntary 340B Repository Data Element Reporting Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10930	340B Repository Data Element Reporting Form	Appendix A_ 340B Repository Data Elements Collection Form_OSORA Copy Clean_07.09.25.xlsx	Yes	Yes	Fillable Fileable
Instruction			Appendix A _340B Data Elements Instruction_OSORA 508 Copy.pdf	Yes	No	Printable Only
Other-PRA Disclosure Statement			PRA Disclosure Statement_Inflation Rebate ICR.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,000	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	26,000	26,000
Annual IC Time Burden (Hours)	208,000	208,000
Annual IC Cost Burden (Dollars)	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.

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