Rebate Reduction Request Form

Rebate Reduction Requests underSections 11101 and 11102 of the Inflation Reduction Act (CMS-10858) - IRA

OMB: 0938-1474

IC ID: 268246

Documents and Forms

Document Name Document Type
Form CMS-10858 Rebate Reduction Request Form Form and Instruction
CMS-10858 Appendix A and BSevere Supply Chain Disruption forms 508_Final clean 30 day notice Appendix A and B_Severe Supply Chain Disruption forms.docx Form and Instruction
CMS-10858 Appendix C and D Likely to be in Shortage forms 508_Final clean 30 day notice Appendix C and D_Likely to be in Shortage forms.docx Form and Instruction
508_Final redline 30 day notice Appendix A and B_Severe Supply Chain Disruption forms (compared to 60-day).docx Redline Appendix A and B IC Document
508_Final redline 30 day notice Appendix C and D_Likely to be in Shortage forms (compared to 60-day).docx Redline Appendix C and D IC Document