Information Collection

Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153)

IC 8242 under ICR 201403-0938-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153)	Form
CMS-R-153 Medicaid Drug Utilization Review Annual Report DUR SURVEY revised 2-26-2014- PRAcopy.pdf	Form
CMS-R-153 Medicaid Drug Utilization Review Annual Report CMS-R-153 [URL].docx	Form
Crosswalk for Medicaid DUR Report 2-26-14.docx Crosswalk	IC Document

IC Title:

Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 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	CMS-R-153	Medicaid Drug Utilization Review Annual Report	DUR SURVEY revised 2-26-2014- PRAcopy.pdf		Yes	Yes	Fillable Printable
Form	CMS-R-153	Medicaid Drug Utilization Review Annual Report	CMS-R-153 [URL].docx		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 Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	51	-128	-25	204
Annual IC Time Burden (Hours)	1,632	85	17	1,530
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	Crosswalk for Medicaid DUR Report 2-26-14.docx	03/19/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.