Information Collection

Negotiation Data Elements ICR Form

IC 272617 under ICR 202411-0938-010 · OMB 0938-1452.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1452 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10849 Negotiation Data Elements ICR Form	Form and Instruction
Form CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negotiation Process ICR Form Negotiation Data Elements ICR Form	Form and Instruction
CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negoti CMS 10849 NDE Process.docx	Form and Instruction
CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negoti clean CMS 10849 NDE Process ICR Forms FINAL.docx	Form and Instruction
redline CMS 10849 NDE Process ICR Forms FINAL.pdf Redline CMS 10849 NDE Process ICR Forms	IC Document

IC Title:

Negotiation Data Elements ICR Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10849				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 340

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	340	340
Annual IC Time Burden (Hours)	20,700	20,700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Redline CMS 10849 NDE Process ICR Forms		01/06/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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