Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Claims Data and Other Record Reports Preparation (42 CFR 456.709) New 204 408 0
Interventions (42 CFR 456.711) New 204 12240 0
Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153, CMS-R-153a, CMS-R-153b, and CMS-R-153c)(42 CFR 456.712) Modified 204 1530 0 Form and Instruction CMS-R-153, CMS-R-153a, CMS-R-153b, and CMS-R-153c
Review of Claims Data and Other Record Reports (42 CFR 456.711) New 204 6120 0
Total burden requested under this ICR: 816 20298 0  
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