Information Collection

Negotiation Data Elements ICR Form - Selected Drugs for Negotiation

IC 272617 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 Negotiation Data Elements ICR Form - Selected Drugs for Negotiation	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

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: 20

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	20	5	15
Annual IC Time Burden (Hours)	20,000	5,000	15,000
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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