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Medicaid Drug Ulilization Review (DUR) Annual Report (42 CFR 456.712 and 438.3)

IC 8242 under ICR 202501-0938-007 · OMB 0938-0659.

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Information Collection (IC) Details

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Medicaid Drug Ulilization Review (DUR) Annual Report (42 CFR 456.712 and 438.3)
 
No Modified
 
Mandatory
 
42 CFR 456.712

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-R-153 FFS Annual Surveys FFS Annual Surveys CLEAN (2024 version 1).docx Yes Yes Fillable Printable
Form CMS-R-153 MCO Annual Surveys MCO Annual Surveys CLEAN (2024 version 1).docx Yes Yes Fillable Fileable
Form CMS-R-153 State DUR Agency Contact Form DUR State Contact Form_2025 Fillable.pdf Yes Yes Fillable Fileable
Form CMS-R-153 Abbreviated MCO Surveys Abbreviated MCO Surveys CLEAN (2024 version 1).docx Yes Yes Fillable Fileable

Health Health Care Services

 

52 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 52 0 0 0 0 52
Annual IC Time Burden (Hours) 3,380 0 0 0 0 3,380
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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