Information Collection

Negotiation Data Elements ICR Form - Selected Drugs for Renegotiation

IC 278115 under ICR 202511-0938-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 - Selected Drugs for Renegotiation	Form and Instruction
Form CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negotiation Process ICR Form Negotiation Data Elements ICR Form - Selected Drugs for Renegotiation	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
CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negoti CMS-10849 Initial Price Applicability Year 2028 Drug Price Negotiation Final ICR Forms.docx	Form and Instruction
Redline CMS 10949 IPAY 2028 Drug Price Negotiation 30-day ICR Forms.pdf Redline CMS 10849 NDE Process ICR Forms	IC Document
Redline CMS 10949 IPAY 2028 Drug Price Negotiation 30-day ICR Forms.pdf Redline CMS 10849 NDE Process ICR Forms	IC Document
Final 30-day redline CMS-10849 Initial Price Applicability Year 2028 Drug Price Negotiation Final ICR Forms.pdf Final 30-day_Redline CMS 10849 NDE Process ICR Forms	IC Document

IC Title:

Negotiation Data Elements ICR Form - Selected Drugs for Renegotiation

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: 350

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	24,450	24,450
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		11/24/2025
Final 30-day_Redline CMS 10849 NDE Process ICR Forms		01/09/2026

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

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