Information Collection

Hospital Enrollment, Additions and Recertifcations

IC 190345 under ICR 202601-0915-001 · OMB 0915-0327.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1.1 340B Registration DSH Parent.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.2 340B Registration Children's Hospital.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.3 340B Registration CAN Parent.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.4 340B Registration Hospital Outpatient Facility.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.5 340B Registration RRC and SCH Parent.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.6 340B Registration CAH Parent.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.7 340B Recertification DSH.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.8 340B Recertification SCH and RRC.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.9 340B Recertification Childrens Hospital.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.10 340B Recertification CAH.pdf Hospital Enrollment, Additions and Recertifcations	Form
Form 1.11 340B Recertification CAN.pdf Hospital Enrollment, Additions and Recertifcations	Form
1.1 340B Registration DSH Parent.pdf 340B Registration DSH Parent.pdf	Form
1.2 340B Registration Children's Hospital.pdf 340B Registration Children's Hospital.pdf	Form
1.3 340B Registration CAN Parent.pdf 340B Registration Free Standing Cancer.pdf	Form
1.4 340B Registration Hospital Outpatient Facility.pdf 340B Registration- Outpatient Facility.pdf	Form
1.5 340B Registration RRC and SCH Parent.pdf 340B Registration Rural Referral and Sole Community Hospitals.pdf	Form
1.6 340B Registration CAH Parent.pdf 340B Registration-CAH.pdf	Form
1.7 340B Recertification DSH.pdf 340B Recertification DSH.pdf	Form
1.8 340B Recertification SCH and RRC.pdf 340B Recertification Sole-community; Rural-Referral centers.pdf	Form
1.9 340B Recertification Childrens Hospital.pdf 340B Recertification Children's Hospital.pdf	Form
1.10 340B Recertification CAH.pdf 340B Recertification-CAH.pdf	Form
1.11 340B Recertification CAN.pdf 340B Recertification Free Standing Cancer.pdf	Form
340B Registration Children's Hospital Redline.pdf 340B Registration Children's Hospital Redline	IC Document
340B Registration DSH Parent Redline.pdf 340B Registration DSH Parent Redline	IC Document
340B Registration Free Standing Cancer Redline.pdf 340B Registration Free Standing Cancer Redline	IC Document
340B Registration- Outpatient Facility Redline.pdf 340B Registration- Outpatient Facility Redline	IC Document
340B Registration Rural Referral and Sole Community Hospitals Redline.pdf 340B Registration Rural Referral and Sole Community Hospitals Redline	IC Document
340B Registration-CAH Redline.pdf 340B Registration-CAH Redline	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Hospital Enrollment, Additions and Recertifcations

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1.1	Yes	Yes	Fillable Fileable
Form	1.2	Yes	Yes	Fillable Fileable
Form	1.3	Yes	Yes	Fillable Fileable
Form	1.4	Yes	Yes	Fillable Fileable
Form	1.5	Yes	Yes	Fillable Fileable
Form	1.6	Yes	Yes	Fillable Fileable
Form	1.7	Yes	Yes	Fillable Fileable
Form	1.8	Yes	Yes	Fillable Fileable
Form	1.9	Yes	Yes	Fillable Fileable
Form	1.10	Yes	Yes	Fillable Fileable
Form	1.11	Yes	Yes	Fillable Fileable

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: 3,907

Number of Respondents for Small Entity: 17

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	41,475	10,824	30,651
Annual IC Time Burden (Hours)	12,224	3,247	8,977
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
340B Registration Children's Hospital Redline		01/08/2026
340B Registration DSH Parent Redline		01/08/2026
340B Registration Free Standing Cancer Redline		01/08/2026
340B Registration- Outpatient Facility Redline		01/08/2026
340B Registration Rural Referral and Sole Community Hospitals Redline		01/08/2026
340B Registration-CAH Redline		01/08/2026

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

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