Submission of Administrative Changes for Any Manufacturer

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

Documents and Forms

Document Name Document Type
Form 5 Submission of Administrative Changes for Any Manufacturer Form and Instruction
5 340B Manufacturer Change Form.pdf 340B Manufacturer Change Form.pdf Form and Instruction
5 340B Manufacturer Change Form.pdf 340B Manufacturer Change Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Submission of Administrative Changes for Any Manufacturer	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 and Instruction	5	340B Manufacturer Change Form.pdf	340B Manufacturer Change Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 350	Number of Respondents for Small Entity: 120

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	175	175
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.