Information Collection

Evaluation of the Medicare National Competitive Bidding Program for DME

IC 46619 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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: 12,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	12,000	12,000
Annual IC Time Burden (Hours)	6,000	6,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.