Information Collection

Public Feedback for one initial price applicability year

IC 280785 under ICR 202611-0938-004 · 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 Public Feedback for one initial price applicability year	Form and Instruction
CMS-10849 Negotiation Data Elements ICR Form and Drug Price Negoti Forms CMS-10849 Initial Price Applicability Year (2029) Final Drug Price Negotiation ICR_clean_.docx	Form and Instruction
Redline_Drug Price Negotiation Form_508.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: 325

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	325	325
Annual IC Time Burden (Hours)	5,700	5,700
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		11/05/2026

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

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