View Information Collection (IC)

View Information Collection (IC)

IC Title:	Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534	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
Other-PRA Discolosure Statement			367 disclosure statement.doc		Yes	No	Printable Only
Instruction			CMS-367 Instructions to Labelers.doc		Yes	No	Printable Only
Form	CMS-367a, 367b, 367c, and 367d	CMS Record Specification and Rebate Agreement	CMS-367 Record File Layout.doc		Yes	Yes	Printable Only

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: 600	Number of Respondents for Small Entity: 100

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

Percentage of Respondents Reporting Electronically: 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	14,024	4,424	0	160	0	9,440
Annual IC Time Burden (Hours)	775,591	633,511	0	2,368	0	139,712
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

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.