Pharmaceutical Pricing Agreement and PPA Addendum

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 6 Pharmaceutical Pricing Agreement and PPA Addendum Form and Instruction
6 Manufacturer PPA.pdf Manufacturer PPA.pdf Form and Instruction
6 Manufacturer PPA.pdf Manufacturer PPA.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Pharmaceutical Pricing Agreement and PPA Addendum	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	6	Manufacturer PPA.pdf	Manufacturer PPA.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 70

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

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	200	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.