Information Collection

DDR Product Data (CMS-367c)

IC 222506 under ICR 202606-0938-019 · OMB 0938-0578.

Documents and Forms

Document Name Document Type
Form CMS-367c MDP Product Data DDR Product Data (CMS-367c) Form and Instruction
CMS-367c MDP Product Data CMS-367c_Clean_508.pdf Form and Instruction
CMS-367c_REDLINE.pdf Redline: CMS-367c (MDP Product Data) IC Document
CMS-367c Crosswalk_508.pdf Crosswalk: CMS-367c (MDP Product Data) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DDR Product Data (CMS-367c)	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-367c	MDP Product Data	CMS-367c_Clean_508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 840	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	840	22	818
Annual IC Time Burden (Hours)	36,540	957	35,583
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Redline: CMS-367c (MDP Product Data)	CMS-367c_REDLINE.pdf	06/26/2026
Crosswalk: CMS-367c (MDP Product Data)	CMS-367c Crosswalk_508.pdf	06/26/2026

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

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