OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368)

OMB 0938-0582 · HHS/CMS.

OMB 0938-0582

Section 1927 of the Social Security Act requires each State Medicaid agency to report quarterly prescription drug utilization information to drug manufacturers and to CMS via form CMS-R-144. As part of this information, the State Medicaid agencies are required to report the total Medicaid rebate amount they claim they are owed by each drug manufacturer for each covered prescription drug product each quarter.

The latest form for Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368) expires 2027-06-30 and is listed under ICR 202404-0938-010.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-368 State Agency Contact Form (CMS-368)Form
Form CMS-R-144 Quarterly Utilization Report (CMS-R-144)Form
CMS-368 and -R-144 - Supporting Statement A (2024 version 4).docxSupporting Statement A
State Agency Contact Form (CMS-368) Form
Quarterly Utilization Report (CMS-R-144) Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202404-0938-010 Extension without change of a currently approved collection 2024-04-15 Approved without change
202111-0938-011 No material or nonsubstantive change to a currently approved collection 2022-02-17 Approved without change
202102-0938-017 Revision of a currently approved collection 2021-03-01 Approved without change
202006-0938-018 Revision of a currently approved collection 2020-06-30 Comment filed on proposed rule and continue
202003-0938-010 Revision of a currently approved collection 2020-04-09 Approved without change
201901-0938-006 No material or nonsubstantive change to a currently approved collection 2019-01-29 Approved with change
201704-0938-011 Extension without change of a currently approved collection 2017-06-21 Approved without change
201407-0938-012 Extension without change of a currently approved collection 2014-07-23 Approved without change
201110-0938-010 Revision of a currently approved collection 2011-10-25 Approved without change
201107-0938-012 Revision of a currently approved collection 2011-07-25 Improperly submitted and continue
200904-0938-007 Extension without change of a currently approved collection 2009-04-14 Approved without change
200604-0938-007 Revision of a currently approved collection 2006-04-21 Approved without change
200307-0938-008 Extension without change of a currently approved collection 2003-07-25 Approved without change
200007-0938-002 Extension without change of a currently approved collection 2000-07-03 Approved without change
199706-0938-010 Extension without change of a currently approved collection 1997-06-25 Approved without change
199410-0938-019 Reinstatement with change of a previously approved collection 1994-10-12 Approved without change
199204-0938-004 Extension without change of a currently approved collection 1992-04-15 Approved without change
199105-0938-006 Revision of a currently approved collection 1991-05-17 Approved without change
199104-0938-001 New collection (Request for a new OMB Control Number) 1991-04-09 Approved without change

OMB Details

State Agency Contact Form (CMS-368)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form CMS-368State Agency Contact FormFillable PrintableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.