Medicare Part B Drug and Biological Competitive Acquisition Program Applications

ICR 200505-0938-007

OMB: 0938-0955

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
0938-0955 200505-0938-007
Historical Active
HHS/CMS
Medicare Part B Drug and Biological Competitive Acquisition Program Applications
New collection (Request for a new OMB Control Number)   No
Emergency 06/02/2005
Approved with change 07/05/2005
Retrieve Notice of Action (NOA) 05/27/2005
  Inventory as of this Action Requested Previously Approved
11/30/2005 11/30/2005
25 0 0
1,000 0 0
0 0 0

This request includes both the CAP vendor/supplier bidding forms and the physician election form. The CAP vendor/supplies bidding form will be used by potential vendors to provide information related to the characteristics of their company, record their bid prices for CAP drugs, and provide information about the company's financies. The physician election form will be used by physicians to elect to participate in the CAP Program.

None
None


No

1
IC Title Form No. Form Name
Medicare Part B Drug and Biological Competitive Acquisition Program Applications CMS-10133

  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 25 0 0 25 0 0
Annual Time Burden (Hours) 1,000 0 0 1,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
05/27/2005


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