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Federal forms, ICRs, and supporting documents

Information Collection

Submission of Administrative Changes for Any Manufacturer

IC 203460 under ICR 202601-0915-001 · OMB 0915-0327.

Documents and Forms
Document Name
Document Type
Form
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Submission of Administrative Changes for Any Manufacturer
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 5 340B Manufacturer Change Form.pdf 340B Manufacturer Change Form.docx.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

471 161
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested 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 471 0 121 0 0 350
Annual IC Time Burden (Hours) 236 0 61 0 0 175
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
340B Manufacturer Change Form Redline 340B Manufacturer Change Form Redline.pdf 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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