General Public (individual and organization)

Negotiation Data Elements under Sections 11001 and 11002 of the Inflation Reduction Act (CMS-10847)

Documents and Forms

Document Name Document Type
Form CMS-10847 General Public (individual and organization) Form and Instruction
CMS-10847 Negotiation Data Elements Form Negotiation Data Elements ICR_508 final.pdf Form and Instruction
CMS-10847 Negotiation Data Elements Form Clean Final NDE ICR FINAL.docx Form and Instruction

Information Collection (IC) Details

IC Title:	General Public (individual and organization)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10847	Negotiation Data Elements Form	Clean Final NDE ICR FINAL.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	3,300	3,300
Annual IC Time Burden (Hours)	12,000	12,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.