Information Collection

Pharmaceutical Pricing Agreement and PPA Addendum

IC 221302 under ICR 202601-0915-001 · OMB 0915-0327.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6 Manufacturer PPA.pdf Pharmaceutical Pricing Agreement and PPA Addendum	Form
6 Manufacturer PPA.pdf Manufacturer PPA.pdf	Form
Manufacturer PPA Redline.pdf Manufacturer PPA Redline	IC Document

IC Title:

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	6				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 73

Number of Respondents for Small Entity: 26

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	73	-127	200
Annual IC Time Burden (Hours)	73	-127	200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Manufacturer PPA 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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