Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

Supporting Statement For Paperwork Reduction Act Submissions - Request for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program and Suppo

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1016 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10169 Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Form
CMS-10169.Instructions.doc Instruction
CMS-10169 MASTER Instructions-3-27-07.doc Instruction
CMS-10169 CMS-10169 Form A CMS-10169A (2).pdf Form
CMS-10169 CMS-10169 Form B CMS-10169B.pdf Form
CMS-10169 CMS-10169 Form C CMS-10169C (2).pdf Form
CMS-10169 CMS-10169 Form A CMS-10169.Form A.pdf Form
CMS-10169 CMS-10169 Form A- Screenshots CMS-10169.Form A - screen shots.doc Form
CMS-10169 CMS 10169 Form B CMS-10169.Form B.pdf Form
CMS-10169 Form B CMS-10169 Form B- Tab Screens CMS-10169.Form B Tab Screens.doc Form
CMS-10169 Form B CMS-10169 Form B-Screen shot CMS-10169.Form B Wizard Screens.doc Form
CMS-10169 CMS-10169 CMS-10169.Form C.pdf Form
CMS-10169 Form A CMS-10169 Form A Wizard Screens CMS.10169.Form A Wizard Screens.doc Form

Information Collection (IC) Details

IC Title:	Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10169	CMS-10169 Form A	CMS-10169A (2).pdf	Yes	Yes	Fillable Fileable
Form	CMS-10169	CMS-10169 Form B	CMS-10169B.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10169	CMS-10169 Form C	CMS-10169C (2).pdf	Yes	Yes	Fillable Fileable
Instruction			CMS-10169.Instructions.doc	Yes	No	Paper Only
Form	CMS-10169	CMS-10169 Form A	CMS-10169.Form A.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10169	CMS 10169 Form B	CMS-10169.Form B.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10169	CMS-10169 Form A- Screenshots	CMS-10169.Form A - screen shots.doc	Yes	Yes	Fillable Fileable
Form	CMS-10169	CMS-10169	CMS-10169.Form C.pdf	Yes	Yes	Fillable Fileable
Instruction			CMS-10169 MASTER Instructions-3-27-07.doc	Yes	No	Paper Only
Form	CMS-10169 Form A	CMS-10169 Form A Wizard Screens	CMS.10169.Form A Wizard Screens.doc	Yes	Yes	Fillable Fileable
Form	CMS-10169 Form B	CMS-10169 Form B- Tab Screens	CMS-10169.Form B Tab Screens.doc	Yes	Yes	Fillable Fileable
Form	CMS-10169 Form B	CMS-10169 Form B-Screen shot	CMS-10169.Form B Wizard Screens.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,973	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,973	15,973
Annual IC Time Burden (Hours)	1,086,164	1,086,164
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.