Non-MTF User to Complete Drug Price Negotiation Program MTF DM Complaint Intake Form

Medicare Transaction Facilitator for 2026 and 2027 under Sections 11001 and 11002 of the Inflation Reduction Act (IRA) (CMS-10912)

OMB:

IC ID: 274493

Documents and Forms

Document Name Document Type
Form CMS-10912 Non-MTF User to Complete Drug Price Negotiation Program MTF DM Complaint Intake Form Form and Instruction
CMS-10912 Drug Price Negotiation Program Complaint Information Collection Request (ICR) Form for Non-MTF Users non MTF User Form Complaints_v2.docx Form and Instruction