State Drug Rebate (Medicaid)

ICR 200604-0938-007

OMB: 0938-0582

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
8197 Migrated
ICR Details
0938-0582 200604-0938-007
Historical Active 200307-0938-008
HHS/CMS
State Drug Rebate (Medicaid)
Revision of a currently approved collection   No
Regular
Approved without change 07/06/2006
Retrieve Notice of Action (NOA) 04/21/2006
  Inventory as of this Action Requested Previously Approved
07/31/2009 07/31/2009 09/30/2006
204 0 204
9,389 0 6,125
0 0 134,000

Section 1927 requires each State Medicaid agency to report quarterly prescription drug utilization information to drug manufacturers and to CMS. As part of this information, the State Medicaid agencies are required to report the total Medicaid rebate amount they claim they are owed by each drug manufacturer for each covered prescription drug product each quarter.

None
None


No

1
IC Title Form No. Form Name
State Drug Rebate (Medicaid) CMS-368, CMS-R-144

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 204 204 0 0 0 0
Annual Time Burden (Hours) 9,389 6,125 0 0 3,264 0
Annual Cost Burden (Dollars) 0 134,000 0 0 -134,000 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/21/2006


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