View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Hospital Enrollment, Additions and Recertifcations
 
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 1.1 340B Registration DSH Parent.pdf 340B Registration DSH Parent..pdf Yes Yes Fillable Fileable
Form 1.2 340B Registration Children's Hospital PED Parent.pdf 340B Registration PED Parent..pdf Yes Yes Fillable Fileable
Form 1.3 340B Registration CAN Parent.pdf 340B Registration CAN Parent..pdf Yes Yes Fillable Fileable
Form 1.4 340B Registration Hospital Outpatient Facility.pdf 340B Registration Hospital Outpatient Facility..pdf Yes Yes Fillable Fileable
Form 1.5 340B Registration RRC and SCH Parent.pdf 340B Registration RRC and SCH Parent..pdf Yes Yes Fillable Fileable
Form 1.6 340B Registration CAH Parent.pdf 340B Registration CAH Parent..pdf Yes Yes Fillable Fileable
Form 1.7 340B Recertification DSH.pdf 340B Recertification DSH..pdf Yes Yes Fillable Fileable
Form 1.8 340B Recertification SCH and RRC.pdf 340B Recertification SCH and RRC.pdf Yes Yes Fillable Fileable
Form 1.9 340B Recertification PED.pdf 340B Recertification PED..pdf Yes Yes Fillable Fileable
Form 1.10 340B Recertification CAH.pdf 340B Recertification CAH..pdf Yes Yes Fillable Fileable
Form 1.11 340B Recertification CAN.pdf 340B Recertification CAN.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

3,394 15
   
Private Sector Not-for-profit institutions
 
   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 30,378 0 30,184 0 0 194
Annual IC Time Burden (Hours) 9,358 0 8,970 0 0 388
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Registration DSH 340B Registration DSH.docx 08/12/2019
Registration PED 340B Registration Children's Hospital.docx 08/12/2019
Registration CAN 340B Registration Free Standing Cancer Hospital.docx 08/12/2019
Registration Outpatient 340B Registration Outpatient.docx 08/12/2019
Registration SCH and RRC 340B Registration SCH and RRC.docx 08/12/2019
REDLINE Registration CAH 340B Registration CAH.docx 08/12/2019
REDLINE Recert DSH Recert DSH.docx 08/12/2019
REDLINE Recert SCH and RRC Recert RRC and SCH.docx 08/12/2019
REDLINE Recert PED Recert Childrens PED.docx 08/12/2019
REDLINE Recert CAH Recert CAH.docx 08/12/2019
REDLINE Recert CAN Recert CAN.docx 08/12/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.