Information Collection

Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153, CMS-R-153a, CMS-R-153b, and CMS-R-153c)(42 CFR 456.712)

IC 8242 under ICR 201102-0938-003 · OMB 0938-0659.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0659 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
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
CMS-R-153, CMS-R-1 Medicaid Drug Utilization Review Annual Report 07-28-10 MEDICAID DRUG UTILIZATION REVIEW FINAL (2).pdf	Form and Instruction

IC Title:

Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153, CMS-R-153a, CMS-R-153b, and CMS-R-153c)(42 CFR 456.712)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 456.700 42 CFR 456.709 42 CFR 456.711 42 CFR 456.712

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-153, CMS-R-153a, CMS-R-153b, and CMS-R-153c	Medicaid Drug Utilization Review Annual Report	07-28-10 MEDICAID DRUG UTILIZATION REVIEW FINAL (2).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	204	154	50
Annual IC Time Burden (Hours)	1,530	-653,537	655,067
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.