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
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 Revised MTM Program Standardized Format (English & Spanish)(v07.06.2021).docx Yes Yes Fillable Fileable

Health Health Care Services


807 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 2,386,955 0 213,701 0 0 2,173,254
Annual IC Time Burden (Hours) 1,591,383 0 142,475 0 0 1,448,908
Annual IC Cost Burden (Dollars) 2,219,868 0 2,219,868 0 0 0

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