340B Registration for all other covered entities

340B Drug Pricing Program Forms

OMB: 0915-0327

IC ID: 190349

Information Collection (IC) Details

View Information Collection (IC)

340B Registration for all other covered entities
 
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 and Instruction 1 340BRegistration-Covered Entities - Community Health Center 340BRegistration-Covered Entities - Community Health Center.docx Yes Yes Fillable Fileable
Form and Instruction 2 340BRegistration-Covered Entities All Other-Revised 340BRegistration-Covered Entities All Other-Revised.docx Yes Yes Fillable Fileable
Form and Instruction 3 340BRegistration-Covered Entities STD-Revised 340BRegistration-Covered Entities STD-Revised.docx Yes Yes Fillable Fileable
Form and Instruction 4 340BRegistration-Covered Entities TB-Revised 340BRegistration-Covered Entities TB-Revised.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,479 150
   
State, Local, and Tribal Governments
 
   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 2,958 0 2,352 0 0 606
Annual IC Time Burden (Hours) 2,958 0 2,352 0 0 606
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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