Information Collection

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

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-153 Medicaid Drug Ulilization Review (DUR) Annual Report (42 CFR 456.712 and 438.3)	Form
Form CMS-R-153 FFS Annual Surveys Medicaid Drug Ulilization Review (DUR) Annual Report (42 CFR 456.712 and 438.3)	Form
Form CMS-R-153 MCO Annual Surveys Medicaid Drug Ulilization Review (DUR) Annual Report (42 CFR 456.712 and 438.3)	Form
Form CMS-R-153 State DUR Agency Contact Form Medicaid Drug Ulilization Review (DUR) Annual Report (42 CFR 456.712 and 438.3)	Form
Form CMS-R-153 Abbreviated MCO Surveys Medicaid Drug Ulilization Review (DUR) Annual Report (42 CFR 456.712 and 438.3)	Form
CMS-R-153 FFS Annual Surveys FFS Annual Surveys CLEAN (2024 version 1).docx	Form
CMS-R-153 FFS Annual Surveys FFS Annual Surveys CLEAN (2024 version 1).docx	Form
CMS-R-153 MCO Annual Surveys MCO Annual Surveys CLEAN (2024 version 1).docx	Form
CMS-R-153 MCO Annual Surveys MCO Annual Surveys CLEAN (2024 version 1).docx	Form
CMS-R-153 State DUR Agency Contact Form DUR State Contact Form_2025 Fillable.pdf	Form
CMS-R-153 State DUR Agency Contact Form DUR State Contact Form_2025 Fillable.pdf	Form
CMS-R-153 Abbreviated MCO Surveys Abbreviated MCO Surveys CLEAN (2024 version 1).docx	Form
CMS-R-153 Abbreviated MCO Surveys Abbreviated MCO Surveys CLEAN (2024 version 1).docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 456.712

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-153	Yes	Yes	Fillable Printable
Form	CMS-R-153	Yes	Yes	Fillable Fileable
Form	CMS-R-153	Yes	Yes	Fillable Fileable
Form	CMS-R-153	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	3,380	3,380
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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