Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
340B Program Registrations amp; Certifications for Children's Hospitals Removed 0 0 0 Form 1
Form 2
Form 3
340B Program Registrations amp; Certifications for Free Standing Cancer Hospitals Removed 0 0 0 Form 1
340B Program Registrations amp; Certifications for Rural Referral Hospitals Removed 0 0 0 Form 1
340B Program Registrations amp; Certifications for Sole Community Hospitals Removed 0 0 0 Form 1
340B Program Registrations and Certifications for Critical Access Hospitals Removed 0 0 0 Form 1
340B Program Registrations and Certifications for Hospitals Modified 194 388 0 Form 1
Form 2
Form 3
Form 4
Form 5
Form 6
Form 7
340B Registration for all other covered entities Modified 405 405 0 Form and Instruction 1
Administrative Change Form Unchanged 9396 4698 0 Form and Instruction 1
Administrative Changes for Any Manufacturer Unchanged 350 175 0 Form 1
Annual Recertificaion for STD amp; TB Unchanged 3123 781 0 Form 1
Form 2
Annual Recertification for Community Health Centers Modified 6020 1505 0 Form 1
Annual Recertification for Other Entities Modified 4899 1225 0 Form 2
Certification to Enroll Hospitals' Outpatient facilities to 340B Program Modified 5576 2788 0 Form and Instruction 1
Contract Pharmacy Registration Form Modified 8790 8790 0 Form 1
Form 2
Hospital Annual Recertification Unchanged 12804 3201 0 Form 2
Form 1
Form 3
Manufacturer Data Required to Verify 340 B Ceiling Price Calculations Unchanged 2400 1200 0 Form 1
Pharmaceutical Pricing Agreement Unchanged 200 200 0 Form and Instruction 1
Pharmaceutical Pricing Agreement Addendum New 620 310 0 Form 1
Instruction
Registrations for Community Health Centers New 1281 1281 0 Form and Instruction 1
Registrations for STD/TB Clinics New 647 647 0 Form and Instruction 1
Form and Instruction 2
Total burden requested under this ICR: 56705 27594 0  
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