Information Collection Request
Medication Therapy Management Program – Standardized Format (CMS-10396)
ICR 202301-0938-010 · OMB 0938-1154 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1154 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 CMS-10396_Supporting Statement_A (CMS-4102-P version 6).docx |
Supporting Statement A | Uploaded 2023-01-18 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 199672 |  Conducting CMRs with the standardized format and Fulfillment burden |
Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1154 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202104-0938-012 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |