Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Dispensing Entity to Complete Drug Price Negotiation Program MTF DM Dispensing Entity and Third-Party Support Entity Enrollment Form New 56860 460560 0 Form and Instruction CMS-10912 CMS-10912.MTF_ICR_DispensingEntityEnrollmentForm_clean
Non-MTF User to Complete Drug Price Negotiation Program MTF DM Complaint Intake Form New 25050 50100 0 Form and Instruction CMS-10912 CMS-10912. 2025.05.08_MTF_ICR_Complaints&DisputesForm_clean
Primary Manufacturer and/or Dispensing Entity to Complete Drug Price Negotiation Program Complaint and Dispute Intake Form New 11425 293100 0 Form and Instruction CMS-10912 CMS-10912. 2025.05.08_MTF_ICR_Complaints&DisputesForm_clean
Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Payment Elements Form New 25 71500 0 Form and Instruction CMS-10912 CMS-10912.MTF_ICR_ManufacturerPaymentElementsForm_clean
Primary Manufacturer to Complete Drug Price Negotiation Program MTF DM Primary Manufacturer MFP Effectuation Plan Form New 15 2700 0 Form and Instruction CMS-10912 CMS-10912.MTF_ICR_ MFPEffectuationPlanForm_clean
Total burden requested under this ICR: 93375 877960 0  
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