Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368)

ICR 202404-0938-010

OMB: 0938-0582

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-368 State Agency Contact Form (CMS-368) Form	Unchanged
Form CMS-R-144 Quarterly Utilization Report (CMS-R-144) Form	Modified
CMS-368 and -R-144 - Supporting Statement A (2024 version 4).docx Supporting Statement A	2024-04-15

IC Document Collections

IC ID	Document Title	Status
8197	State Agency Contact Form (CMS-368) Form	Unchanged
212418	Quarterly Utilization Report (CMS-R-144) Form	Modified