Information Collection

Medicare Clinical Laboratory Services Competitive Bidding Demonstration Project: Bidding Form

IC 45032 under ICR 200608-0938-004 · OMB 0938-1008.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10193 Medicare Clinical Laboratory Services Competitive Bidding Demonstration Project: Bidding Form	Form
CMS 10193 LAB Competitive Bidding Application Instructions (without Track Changes) 07 06 06 --lebovic 7-12-06.doc	Instruction
CMS-10193 The Medicare Clinical Laboratory Competitive Biddin CMS 10193 LAB Application Form (without Track Changes) 07 06 06 -- jk edits 7-13-06.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10193	The Medicare Clinical Laboratory Competitive Biddin	CMS 10193 LAB Application Form (without Track Changes) 07 06 06 -- jk edits 7-13-06.doc		Yes	Yes	Fillable Printable
Instruction			CMS 10193 LAB Competitive Bidding Application Instructions (without Track Changes) 07 06 06 --lebovic 7-12-06.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	7,000	7,000
Annual IC Cost Burden (Dollars)	4,113	4,113

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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