Information Collection

Rebate Reduction Extension Request Form

IC 268249 under ICR 202405-0938-025 · OMB 0938-1474.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1474 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10858 Rebate Reduction Extension 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 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
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 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
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

Record metadata
IC Title	Rebate Reduction Extension Request Form