Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
340B Registration for all other covered entities Removed 0 0 0 Form and Instruction 1
Annual Recertificaion for STD amp; TB Removed 0 0 0 Form 1
Form 2
Annual Recertification for Community Health Centers Removed 0 0 0 Form 1
Annual Recertification for Other Entities Removed 0 0 0 Form 2
Contract Pharmacy Registration Form Removed 0 0 0 Form 1
Form 2
Contracted Pharmacy Services Registration and Recertifications Modified 22528 22528 0 Form 3.1
Form 3.2
Hospital Enrollment, Additions and Recertifcations Modified 30378 9358 0 Form 1.1
Form 1.2
Form 1.3
Form 1.4
Form 1.5
Form 1.6
Form 1.7
Form 1.8
Form 1.9
Form 1.10
Form 1.11
Manufacturer Data Required to Verify 340 B Ceiling Price Modified 2400 1200 0 Form 7
Pharmaceutical Pricing Agreement Removed 0 0 0 Form and Instruction 1
Pharmaceutical Pricing Agreement and PPA Addendum Modified 200 200 0 Form and Instruction 6
Registrations and Recertifications for Entities other than Hospitals Modified 19451 6368 0 Form and Instruction 2.1
Form and Instruction 2.2
Form and Instruction 2.3
Form 2.4
Form 2.5
Form 2.6
Registrations for Community Health Centers Removed 0 0 0 Form and Instruction 1
Registrations for STD/TB Clinics Removed 0 0 0 Form and Instruction 1
Form and Instruction 2
Submission of Administrative Changes for Any Manufacturer Modified 350 175 0 Form and Instruction 5
Submission of Administrative Changes for any Covered Entities Modified 19322 4831 0 Form 4
Total burden requested under this ICR: 94629 44660 0  
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