OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Voluntary 340B Repository Data Element Reporting Requirements

IC 276684 under ICR 202511-0938-002 · OMB 0938-1485.

Documents and Forms
Document Name
Document Type
Form
Form
Instruction
Instruction
Other-PRA Disclosure Statement
Other-PRA Disclosure Statement
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Voluntary 340B Repository Data Element Reporting Requirements
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10930 340B Repository Data Elements Reporting Example Form 340B Repository Data Elements Reporting Example Form_11.18.25 508.xlsx Yes Yes Fillable Fileable
Instruction 340B Repository Data Elements Reporting Instruction_11.18.25 508.docx Yes No Printable Only
Other-PRA Disclosure Statement CMS-10930 - PRA Disclosure Statement_clean_11.19.25docx.docx Yes No Printable Only

Health Health Care Services

 

2,600 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10,400 0 10,400 0 0 0
Annual IC Time Burden (Hours) 83,200 0 83,200 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Redline: 340B Repository Data Elements Reporting Example Form 340B Repository Data Elements Reporting Example Form_redlines_11.18.25 508.xlsx 11/21/2025
Redline: 340B Repository Data Elements Reporting Instructions 340B Data Elements Reporting Instructions_redline_11.18.25 508.docx 11/21/2025
Crosswalk: 340B Repository Data Elements Reporting Example Form Crosswalk - 340B Repository Data Elements Reporting Example Form_11.18.25 508.docx 11/21/2025
Crosswalk: 340B Repository Data Elements Reporting Instructions Crosswalk - 340B Repository Data Elements Reporting Instructions_11.18.25 508.docx 11/21/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].