Information Collection Requirements Referenced in 42 CFR Section 424.57: Additional DMEPOS Supplier Standards

ICR 200110-0938-002

OMB: 0938-0717

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0717 200110-0938-002
Historical Active 200104-0938-007
HHS/CMS
Information Collection Requirements Referenced in 42 CFR Section 424.57: Additional DMEPOS Supplier Standards
Revision of a currently approved collection   No
Regular
Approved without change 11/30/2001
Retrieve Notice of Action (NOA) 10/01/2001
  Inventory as of this Action Requested Previously Approved
11/30/2004 11/30/2004 12/31/2001
35,000 0 21,800
280,000 0 283,711
0 0 0

Respondents will be supliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). HCFA needs documentation that the DMEPOS supplier has advised beneficiaries that they may either rent or purchase inexpensive or routinely purchased equipment and about the purchase option for capped rental equipment. This is needed to determine if the supplier has met the supplier standards.

None
None


No

1
IC Title Form No. Form Name
Information Collection Requirements Referenced in 42 CFR Section 424.57: Additional DMEPOS Supplier Standards HCFA-R-215

  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 35,000 21,800 0 0 13,200 0
Annual Time Burden (Hours) 280,000 283,711 0 0 -3,711 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
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.
10/01/2001


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