View Information Collection (IC)

View Information Collection (IC)

Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 (CMS-367)
 
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 CMS-367 Medicaid Drug Program Monthly and Quarterly Drug Reporting DDR Screenshots for PRA 3.31.14.docx Yes Yes Fillable Printable
Other-PRA Disclosure Statement Manufacturer Stand-Alone PRA 0938-0578 -CMS-367_disclosure_statement - CLEAN.doc No   Printable Only
Form CMS-367 Record File Specification CMS-367 for OMB - Record Specification - CLEAN - 4.1.14.docx Yes Yes Fillable Printable
Instruction Manufacturer Stand-Alone PRA 0938-0578 - CMS-367_Instructions_to_Labelers - CLEAN.docx Yes No Printable Only

Health Health Care Services

 

610 100
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved 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 10,370 610 0 320 0 9,440
Annual IC Time Burden (Hours) 156,343 11,895 0 4,736 0 139,712
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk - Record Specification Copy of Form Record Specification Crosswalk.xlsx 04/17/2014
Crosswalk - Instructions for Labelers Copy of Instructions for Labelers Crosswalk.xlsx 04/17/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.