Information Collection Request

Medicaid Drug Rebate Program - Manufacturers and Supporting Regulation at 42 CFR 447.534 (CMS-367)

ICR 202304-0938-029 · OMB 0938-0578 · Received in OIRA

Forms and Documents

Document Name	Status
Form CMS-376a DDR Quarterly Pricing Data (CMS-367a) Form	Modified
Form CMS-367e CMS-367e – Quarterly VBP-MBP Data Form	Unchanged
Form CMS-367d Supplemental Data Sheet (CMS-367d) Form	Modified
CMS-367a-e - Supporting Statement A (2023 version 5).docx Supporting Statement A	2023-05-03

IC Document Collections

IC ID	Document Title	Status
8184	DDR Quarterly Pricing Data (CMS-367a) Form	Modified
252237	CMS-367e – System Updates	Removed
252230	CMS-367e – Quarterly VBP-MBP Data Form	Unchanged
222507	Supplemental Data Sheet (CMS-367d) Form	Modified
222506	DDR Product Data (CMS-367c) Instruction	Modified
222505	DDR Monthly Pricing Data (CMS-367b) Instruction	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-0578
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202203-0938-002
Agency Tracking No	CMCS
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31