Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Primary Manufacturer MFP Effectuation Plan Form

Medicare Transaction Facilitator for 2026 and 2027 under Sections 11001 and 11002 of the Inflation Reduction Act (IRA) (CMS-10912)

Documents and Forms

Document Name Document Type
Form CMS-10912 Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Primary Manufacturer MFP Effectuation Plan Form Form and Instruction
CMS-10912 MTF DM Primary Manufacturer MFP Effectuation Plan Form 2025.03.07_MTF_ICR_ MFPEffectuationPlanForm_clean.docx Form and Instruction
CMS-10912 CMS-10912.MTF_ICR_ MFPEffectuationPlanForm_clean CMS-10912.MTF_ICR_ MFPEffectuationPlanForm_clean.docx Form and Instruction
2025_03_10MTF_ICR_MFPEffecutationPlan Form_trackchanges.pdf Track Change - MFPEffecutationPlan Form IC Document
2025_03_10MTF_ICR_MFPEffecutationPlan Form_trackchanges.pdf Track Change - MFPEffecutationPlan Form IC Document

Information Collection (IC) Details

IC Title:	Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Primary Manufacturer MFP Effectuation Plan Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

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-10912	CMS-10912.MTF_ICR_ MFPEffectuationPlanForm_clean	CMS-10912.MTF_ICR_ MFPEffectuationPlanForm_clean.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	2,700	2,700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Track Change - MFPEffecutationPlan Form	2025_03_10MTF_ICR_MFPEffecutationPlan Form_trackchanges.pdf	03/19/2025

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