Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Rebate Reduction Extension Request Form	New	10	310	0	Form and Instruction	CMS-10858	Appendix A and BSevere Supply Chain Disruption forms
Rebate Reduction Extension Request Form	New	10	310	0	Form and Instruction	CMS-10858	Appendix C and D Likely to be in Shortage forms
Rebate Reduction Request Form	New	10	310	0	Form and Instruction	CMS-10858	Appendix A and BSevere Supply Chain Disruption forms
Rebate Reduction Request Form	New	10	310	0	Form and Instruction	CMS-10858	Appendix C and D Likely to be in Shortage forms
Total burden requested under this ICR:		20	620	0
To view an IC, click on IC Title