Information Collection

Negotiation Data Elements ICR Form - Selected Drugs for Renegotiation

IC 278115 under ICR 202606-0938-003 · OMB 0938-1452.

Documents and Forms

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 Renegotiation 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Negotiation Data Elements ICR Form - Selected Drugs for Renegotiation	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10849	Negotiation Data Elements ICR Form and Drug Price Negotiation Process ICR Form	CMS-10849 Initial Price Applicability Year (2029) 60-day Drug Price Negotiation ICR Forms_working file.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 361	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	361	11	350
Annual IC Time Burden (Hours)	32,700	8,250	24,450
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Redline CMS 10849 NDE Process ICR Forms	Redline Drug Price Negotiation for Initial Price Applicability Year 2029 Form.pdf	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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