Information Collection

Identification and Selection of Renegotiation-Eligible Drugs

IC 277593 under ICR 202509-0938-014 · OMB 0938-1443.

Documents and Forms

Document Name Document Type
Form CMS-10844 Identification and Selection of Renegotiation-Eligible Drugs Form and Instruction
Form CMS-10844 Negotiation Program Drug Selection Information Collection Forms Identification and Selection of Renegotiation-Eligible Drugs Form and Instruction
CMS-10844 Negotiation Program Drug Selection Information Collectio CMS-10844 Initial Price Applicability Year 2028_ Negotiation Program Drug Selection Information Collection Forms.docx Form and Instruction
CMS-10844 Negotiation Program Drug Selection Information Collectio CMS-10844 Initial Price Applicability Year 2028 Negotiation Program Drug Selection Information Collection Forms.docx Form and Instruction
CMS-10844 Initial Price Applicability Year 2028 30-day Negotiation Program Drug Selection Information Collection Forms redline of proposed changes.pdf Track Change - Negotiation Program Drug Selection Information Collection Forms IC Document
CMS-10844 Initial Price Applicability Year 2028 60-day Drug Selection Information Collection Forms redline of proposed revisions.pdf Track Change - Negotiation Program Drug Selection Information Collection Forms IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Identification and Selection of Renegotiation-Eligible Drugs	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-10844	Negotiation Program Drug Selection Information Collection Forms	CMS-10844 Initial Price Applicability Year 2028 Negotiation Program Drug Selection Information Collection Forms.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	3,125	3,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Track Change - Negotiation Program Drug Selection Information Collection Forms	CMS-10844 Initial Price Applicability Year 2028 60-day Drug Selection Information Collection Forms redline of proposed revisions.pdf	11/07/2025

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

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