Information Collection

Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity and Supporting Documentation

IC 8266 under ICR 200303-0938-007 · OMB 0938-0679.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0679 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

IC Title:

Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity and Supporting Documentation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	CMS-841	Yes	Yes
Form	842	Yes	Yes
Form	844-853	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 137,300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,800,000	42,500	57,500	6,700,000
Annual IC Time Burden (Hours)	1,530,000	170,000	230,000	1,130,000
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.