Conducting CMRs with the standardized format and Fulfillment burden

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

OMB: 0938-1154

IC ID: 199672

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Conducting CMRs with the standardized format and Fulfillment burden
 
No Modified
 
Mandatory
 
42 CFR 423.153 (d)(1)(vii)(D)__ 42 CFR 423.153 (d)(1)(vii)(B)__

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction MTM Program Standardized Format (English & Spanish) (rev OSORA PRA).docx Yes Yes Fillable Fileable

Health Health Care Services

 

591 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 1,211,661 0 0 931,309 0 280,352
Annual IC Time Burden (Hours) 807,774 0 0 620,873 0 186,901
Annual IC Cost Burden (Dollars) 1,696,325 0 0 1,441,205 0 255,120

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