Information Collection

Counteroffer ICR Form

IC 261204 under ICR 202606-0938-003 · OMB 0938-1452.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negotiation Process ICR Form Counteroffer ICR Form	Form and Instruction
Form CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negotiation Process ICR Form Counteroffer ICR Form	Form and Instruction
CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negoti CMS-10849 Initial Price Applicability Year (2029) 60-day Drug Price Negotiation ICR Forms_working file.docx	Form and Instruction
CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negoti CMS-10849 Initial Price Applicability Year (2029) 60-day Drug Price Negotiation ICR Forms_working file.docx	Form and Instruction
Redline Drug Price Negotiation for Initial Price Applicability Year 2029 Form.pdf Redline CMS 10849 NDE Process ICR Forms	IC Document
Redline Drug Price Negotiation for Initial Price Applicability Year 2029 Form.pdf Redline CMS 10849 NDE Process ICR Forms	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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: 56

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56	16	40
Annual IC Time Burden (Hours)	11,438	3,268	8,170
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Redline CMS 10849 NDE Process ICR Forms		06/05/2026

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

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