Information Collection Request

Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368)

ICR 202006-0938-018 · OMB 0938-0582 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-368 State Agency Contact Form (CMS-368) Form Unchanged Available
CMS-368 and R-144 - Supporting Statement A (CMS-2482-P version 3).docx Supporting Statement A Uploaded 2020-06-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8197 State Agency Contact Form (CMS-368) Form Unchanged
212418 Quarterly Utilization Report (CMS-R-144) Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2023 36 Months From Approved 06/30/2023
234 0 234
12,101 0 12,101
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Quarterly Utilization Report (CMS-R-144) CMS-R-144 Medicaid Drug Rebate Invoice
State Agency Contact Form (CMS-368) CMS-368 State Agency Contact Form



Reginfo record details
  No