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

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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 FFY 2015 Final Medicaid DUR Report 1-28-16 508 v1.pdf www.surveygizmo.com/s3/2517110/FFY-2015-Medicaid-Drug-Utilization-Review-Annual-Report-Copy-December-29-2015 Form
Crosswalk for Medicaid DUR Report FFY2015.pdf Annual Report Revisions - Crosswalk Format IC Document
DUR FFY 2015 Medicaid DUR report tracked changes.docx Annual Report Revisions - Track Changes Version IC Document

Information Collection (IC) Details

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 456.712

Information Collection 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 FFY 2015 Final Medicaid DUR Report 1-28-16 508 v1.pdf	http://www.surveygizmo.com/s3/2517110/FFY-2015-Medicaid-Drug-Utilization-Review-Annual-Report-Copy-December-29-2015	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	1,632	1,632
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Annual Report Revisions - Crosswalk Format	Crosswalk for Medicaid DUR Report FFY2015.pdf	04/15/2016
Annual Report Revisions - Track Changes Version	DUR FFY 2015 Medicaid DUR report tracked changes.docx	04/15/2016

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