Information Collection Request

Medicaid Drug Utilization Review (DUR) Annual Report (CMS-R-153 and CMS-R-153a, b, and c)

ICR 201102-0938-003 · OMB 0938-0659 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-R-153, CMS-R-1 Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153, CMS-R-153a, CMS-R-153b, and CMS-R-153c)(42 CFR 456.712) Form and Instruction Modified Available
Supporting Statement Part A [rev 03-12-11].doc Supporting Statement A Uploaded 2011-03-14 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2014 36 Months From Approved
816 0 0
20,298 0 0
0 0 0





table that charts list of burden
  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 816 0 0 766 0 50
Annual Time Burden (Hours) 20,298 0 0 -634,769 0 655,067
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No