Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
340B Program Registrations & Certifications for Children's Hospitals New 80 20 0
340B Program Registrations & Certifications for Disproportionate Share Hospitals New 70 18 0
340B Registration for all other covered entities New 170 14 0
Administrative Change Form New 460 38 0
Annual Recertificaion for STD & TB New 1221 101 0
Annual Recertification for Family Planning New 3995 332 0
Annual Recertification for Other Entities New 4000 332 0
Certification to Enroll DSH and Children's Hospitals' Outpatient facilities to 340B Program New 180 15 0
Contract Pharmacy Self Certification Form New 2000 166 0
Hospital Annual Recertification New 937 469 0
Total burden requested under this ICR: 13113 1505 0  
To view an IC, click on IC Title