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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10169 CMS-10169 Form D	Form and Instruction	Modified	Available
Form CMS-10169B CMS-10169B	Form	Modified	Available
Form CMS-10169 CMS-10169 Form C	Form	Modified	Available
Form CMS-10169 CMS-10169 Form A	Form	Modified	Available
Form CMS-10169 CMS-10169	Form	Modified	Available
Justification for Nonmaterial change.doc	Justification for No Material/Nonsubstantive Change	Uploaded 0000-00-00	Available
CMS-10169.Supporting Statement-Part A.FINAL-3-27-07.doc	Supporting Statement A	Uploaded 0000-00-00	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46762	Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	Form and Instruction	Modified	CMS-10169 Form D
46761	Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	Form	Modified	CMS-10169B
46761	Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	Instruction	Modified
46761	Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	Form	Modified	CMS-10169 Form C
46761	Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	Form	Modified	CMS-10169 Form A
179238	Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	Form	Modified	CMS-10169

ICR Details

OMB Control No: 0938-1016	ICR Reference No: 200704-0938-009
Status: Historical Active	Previous ICR Reference No: 200701-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/23/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/25/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2010	04/30/2010	04/30/2010
Responses	39,946	0	39,946
Time Burden (Hours)	1,090,826	0	1,090,826
Cost Burden (Dollars)	0	0	0

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Abstract: CMS will conduct a competitive bidding program in which certain suppliers would be awarded a contract to provide competitively priced items and services to Medicare beneficiaries. Suppliers bidding above the winning price are to be excluded from the Medicare market; however, multiple winners must be awarded in each site. Contract or winning suppliers will be picked from those suppliers bids that have the lowest bids and meet all relevant program requirements. This form will collect all relevant information needed for bidding.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 302(b)(1) Name of Law: Payment for durable medical equipment; competitive acquisition of certain items and services
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AN14	Final or interim final rulemaking	71 FR 25654	05/01/2006

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 26543	05/05/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 75553	12/15/2006
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	CMS-10169, CMS-10169, CMS-10169B	CMS-10169 Form A ,   CMS-10169 Form C ,   CMS-10169B
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	CMS-10169	CMS-10169
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program	CMS-10169	CMS-10169 Form D

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ICR Summary of Burden

table that charts list of burden

	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	39,946	39,946	0	0	0	0
Annual Time Burden (Hours)	1,090,826	1,090,826	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $616

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/17/2007

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