Information Collection

Voluntary 340B Repository Data Element Reporting Requirements

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10930 Voluntary 340B Repository Data Element Reporting Requirements	Form
Form CMS-10930 340B Repository Data Elements Reporting Example Form Voluntary 340B Repository Data Element Reporting Requirements	Form
340B Repository Data Elements Reporting Instruction_11.18.25 508.docx	Instruction
340B Repository Data Elements Reporting Instruction_11.18.25 508.docx	Instruction
CMS-10930 - PRA Disclosure Statement_clean_11.19.25docx.docx	Other-PRA Disclosure Statement
CMS-10930 - PRA Disclosure Statement_clean_11.19.25docx.docx	Other-PRA Disclosure Statement
CMS-10930 340B Repository Data Elements Reporting Example Form 340B Repository Data Elements Reporting Example Form_11.18.25 508.xlsx	Form
CMS-10930 340B Repository Data Elements Reporting Example Form 340B Repository Data Elements Reporting Example Form_11.18.25 508.xlsx	Form
340B Repository Data Elements Reporting Example Form_redlines_11.18.25 508.xlsx Redline: 340B Repository Data Elements Reporting Example Form	IC Document
340B Repository Data Elements Reporting Example Form_redlines_11.18.25 508.xlsx Redline: 340B Repository Data Elements Reporting Example Form	IC Document
340B Data Elements Reporting Instructions_redline_11.18.25 508.docx Redline: 340B Repository Data Elements Reporting Instructions	IC Document
340B Data Elements Reporting Instructions_redline_11.18.25 508.docx Redline: 340B Repository Data Elements Reporting Instructions	IC Document
Crosswalk - 340B Repository Data Elements Reporting Example Form_11.18.25 508.docx Crosswalk: 340B Repository Data Elements Reporting Example Form	IC Document
Crosswalk - 340B Repository Data Elements Reporting Example Form_11.18.25 508.docx Crosswalk: 340B Repository Data Elements Reporting Example Form	IC Document
Crosswalk - 340B Repository Data Elements Reporting Instructions_11.18.25 508.docx Crosswalk: 340B Repository Data Elements Reporting Instructions	IC Document
Crosswalk - 340B Repository Data Elements Reporting Instructions_11.18.25 508.docx Crosswalk: 340B Repository Data Elements Reporting Instructions	IC Document

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: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10930	Yes	Yes	Fillable Fileable
Instruction		Yes	No	Printable Only
Other-PRA Disclosure Statement		Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,600

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,400	10,400
Annual IC Time Burden (Hours)	83,200	83,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Redline: 340B Repository Data Elements Reporting Example Form		11/21/2025
Redline: 340B Repository Data Elements Reporting Instructions		11/21/2025
Crosswalk: 340B Repository Data Elements Reporting Example Form		11/21/2025
Crosswalk: 340B Repository Data Elements Reporting Instructions		11/21/2025

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

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