Information Collection

Evaluation of the Medicare National Competitive Bidding Program for DME

IC 46618 under ICR 200701-0938-005 · OMB 0938-1015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10197 Evaluation of the Medicare National Competitive Bidding Program for DME	Form and Instruction
CMS-10197 Surveys and Evaluation Program Handbook CMS-10197 OMB_DMEBID_Statement and Appendices 11-20-06.pdf	Form and Instruction

IC Title:

Evaluation of the Medicare National Competitive Bidding Program for DME

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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 and Instruction	CMS-10197	Surveys and Evaluation Program Handbook	CMS-10197 OMB_DMEBID_Statement and Appendices 11-20-06.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 665

Number of Respondents for Small Entity: 665

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 86 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	665	665
Annual IC Time Burden (Hours)	551	551
Annual IC Cost Burden (Dollars)	0	0

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.