Information Collection

Covered Entities: Reporting Claims Data to Third Party Platform

IC 280966 under ICR 202606-0906-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 340B Rebate Model Pilot Program Manufacturer Data Fields (Example) Covered Entities: Reporting Claims Data to Third Party Platform	Form
1 340B Rebate Model Pilot Program Manufacturer Data Fields Form - 30Day FRN - 0906-NEW - OPA - 340B Rebate Pilot 6.9.2026.xlsx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,249

Number of Respondents for Small Entity: 15,249

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	792,948	792,948
Annual IC Time Burden (Hours)	3,964,740	3,964,740
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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