Programming the standardized format

Medication Therapy Management Program Improvements - Standardized Format (CMS-10396)

OMB: 0938-1154

IC ID: 199670

Information Collection (IC) Details

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Programming the standardized format
 
No Removed
 
Mandatory
 
42 CFR 423.153 (d)(1)(vii)(B)__ 42 CFR 423.153 (d)(1)(vii)(D)__

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10396 MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT CMS-10396_MTMP_Standardized_Format.pdf Yes No Fillable Fileable

Health Health Care Services

 

673 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 0 -673 0 673
Annual IC Time Burden (Hours) 0 0 0 -80,760 0 80,760
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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