Manufacturer Data Required to Verify 340 B Ceiling Price Calculations

340B Drug Pricing Program Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Manufacturer Data Required to Verify 340 B Ceiling Price Calculations Form
1 Manufacturer Data Fields for 340B Ceiling Price - FINAL Manufacturer Data Fields for 340B Ceiling Price-FINAL VERSION.docx Form

Information Collection (IC) Details

IC Title:	Manufacturer Data Required to Verify 340 B Ceiling Price Calculations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Manufacturer Data Fields for 340B Ceiling Price - FINAL VERSION	Manufacturer Data Fields for 340B Ceiling Price-FINAL VERSION.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 210

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	1,200	1,200
Annual IC Cost Burden (Dollars)	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.