Hospital Annual Recertification

Enrollment and Re-Certification of Entities in the 340B Drug Pricing Program and Collection of Manufacturer Data to Verify 340B Drug Pricing Program Ceiling Price Calculations

⚠️ Notice: This information collection may be referencing outdated material.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 2 Hospital Annual Recertification Form
2 Recert-Critical Access; Sole-community; Rural-Referral c Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised.pdf Form
1 Public Ownership-Revised.docx Hospital Recertification-DSH.pdf Form
3 Recert-Free standing Cancer Hospital (Orphan Drug)-Revis Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf Form

Information Collection (IC) Details

IC Title:	Hospital Annual Recertification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2	Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised	Recert-Critical Access; Sole-community; Rural-Referral centers (Orphan Drug)-Revised.pdf	Yes	Yes	Fillable Fileable
Form	1	Public Ownership-Revised.docx	Hospital Recertification-DSH.pdf	Yes	Yes	Fillable Fileable
Form	3	Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf	Recert-Free standing Cancer Hospital (Orphan Drug)-Revised.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,134	Number of Respondents for Small Entity: 280

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	12,804	12,804
Annual IC Time Burden (Hours)	3,201	3,201
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.