View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Hospital Enrollment, Additions and Recertifcations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

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.pdf	340B Registration Children's Hospital.pdf		Yes	Yes	Fillable Fileable
Form	1.3	340B Registration CAN Parent.pdf	340B Registration Free Standing Cancer.pdf		Yes	Yes	Fillable Fileable
Form	1.4	340B Registration Hospital Outpatient Facility.pdf	340B Registration- Outpatient Facility.pdf		Yes	Yes	Fillable Fileable
Form	1.5	340B Registration RRC and SCH Parent.pdf	340B Registration Rural Referral and Sole Community Hospitals.pdf		Yes	Yes	Fillable Fileable
Form	1.6	340B Registration CAH Parent.pdf	340B Registration-CAH.pdf		Yes	Yes	Fillable Fileable
Form	1.7	340B Recertification DSH.pdf	340B Registration DSH Parent.pdf		Yes	Yes	Fillable Fileable
Form	1.8	340B Recertification SCH and RRC.pdf	340B Registration Rural Referral and Sole Community Hospitals.pdf		Yes	Yes	Fillable Fileable
Form	1.9	340B Recertification Childrens Hospital.pdf	340B Registration Children's Hospital.pdf		Yes	Yes	Fillable Fileable
Form	1.10	340B Recertification CAH.pdf	340B Registration-CAH.pdf		Yes	Yes	Fillable Fileable
Form	1.11	340B Recertification CAN.pdf	340B Registration Free Standing Cancer.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,369	Number of Respondents for Small Entity: 15

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 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	30,651	0	273	0	0	30,378
Annual IC Time Burden (Hours)	8,977	0	-381	0	0	9,358
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.