Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Quarterly Utilization Report (CMS-R-144) Modified 224 12320 0 Form CMS-R-144 Medicaid Drug Rebate Invoice
Instruction
Instruction
Instruction
State Agency Contact Form (CMS-368) Unchanged 10 5 0 Form CMS-368 State Agency Contact Form
Total burden requested under this ICR: 234 12325 0  
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