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

ICR 202301-0938-010

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1154 can be found here:

Forms and Documents

Document Name	Status
CMS-10396_Supporting Statement_A (CMS-4102-P version 6).docx Supporting Statement A	2023-01-18

IC Document Collections

IC ID	Document Title	Status
199672	Conducting CMRs with the standardized format and Fulfillment burden Instruction	Modified

ICR Details