Oxygen Consumer Survey: Medical Equipment and Supplies Consumer Survey

ICR 200105-0938-008

OMB: 0938-0807

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0807 200105-0938-008
Historical Active 200008-0938-002
HHS/CMS
Oxygen Consumer Survey: Medical Equipment and Supplies Consumer Survey
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 07/30/2001
Retrieve Notice of Action (NOA) 05/31/2001
OMB approves this instrument for use in San Antonio, Tx. and other sites selected for the DME Competitive Bidding Demonstra- tion. However, any site-specific revisions to this instrument or the underlying sampling or survey methodologies must be submitted for OMB PRA review prior to implementation. In addition CMS promptly must submit to OMB correction worksheets updating the burden and respondents involved in this demonstration.
  Inventory as of this Action Requested Previously Approved
12/31/2002 12/31/2002
2,500 0 0
725 0 0
0 0 0

This survey is necessary to collect access, quality, and diversity of product selection information from beneficiaries. These key elements of the evaluation cannot be thoroughly evaluated without a beneficiary survey. The information will be presented to HCFA and to Congress, who will use the results to determine whether the demonstration should be extended to other sites. The respondents will be Medicare beneficiaries, that is, those who are age 65 or older or are disabled. These beneficiaries qualify for the survey if they use at least one of the following types of medical equipment: hospital beds,.......

None
None


No

1
IC Title Form No. Form Name
Oxygen Consumer Survey: Medical Equipment and Supplies Consumer Survey HCFA-10016

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,500 0 0 2,500 0 0
Annual Time Burden (Hours) 725 0 0 725 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/31/2001


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