Information Collection Request
Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368)
ICR 202404-0938-010 · OMB 0938-0582 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-368 State Agency Contact Form (CMS-368) |
Form | Unchanged | Missing upstream |
| Form CMS-R-144 Quarterly Utilization Report (CMS-R-144) |
Form | Modified | Repair queued |
 CMS-368 and -R-144 - Supporting Statement A (2024 version 4).docx |
Supporting Statement A | Uploaded 2024-04-15 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8197 |  State Agency Contact Form (CMS-368) |
Form | Unchanged | |
| 212418 | Quarterly Utilization Report (CMS-R-144) |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0582 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202111-0938-011 |
| Agency Tracking No | CMCS |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |