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

View Information Collection (IC)

Voluntary 340B Repository Data Element Reporting Requirements
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10930 Yes Yes Fillable Fileable
Instruction Yes No Printable Only
Other-PRA Disclosure Statement Yes No Printable Only

Health Health Care Services

 

2,600 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 10,400 0 10,400 0 0 0
Annual IC Time Burden (Hours) 83,200 0 83,200 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Redline: 340B Repository Data Elements Reporting Example Form 11/21/2025
Redline: 340B Repository Data Elements Reporting Instructions 11/21/2025
Crosswalk: 340B Repository Data Elements Reporting Example Form 11/21/2025
Crosswalk: 340B Repository Data Elements Reporting Instructions 11/21/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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