Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Contracted Pharmacy Services Registration and Recertifications Modified 48136 48136 0 Form 3.1
Form 3.2
Hospital Enrollment, Additions and Recertifcations Modified 41475 12224 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 and PPA Addendum Modified 73 73 0 Form 6
Registrations and Recertifications for Entities other than Hospitals Modified 24267 7372 0 Form 2.1
Form 2.2
Form 2.3
Form 2.4
Form 2.5
Form 2.6
Submission of Administrative Changes for Any Manufacturer Modified 471 236 0 Form 5
Submission of Administrative Changes for any Covered Entities Modified 24829 6207 0 Form 4
Total burden requested under this ICR: 141651 75448 0  
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