Medicare Part B Drug and Biological Competitive Acquisition Program Applications

ICR 200712-0938-003

OMB: 0938-0955

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2007-12-14
ICR Details
0938-0955 200712-0938-003
Historical Active 200607-0938-001
HHS/CMS
Medicare Part B Drug and Biological Competitive Acquisition Program Applications
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/15/2008
Retrieve Notice of Action (NOA) 12/17/2007
  Inventory as of this Action Requested Previously Approved
08/31/2009 08/31/2009 08/31/2009
12 0 12
480 0 480
0 0 0

The CAP Vendor Application and Bid Form is a collection tool which will be used by potential vendors to provide information related to the characteristics of their company and to submit their bid prices for CAP drugs. The information collected on the CAP Vendor Application and Bid Form will be used by CMS during the bidding evaluaton process to evaluate the vendors bid prices, their credentials, experience and to assess their ability to provide quality service to physicians and beneficiaries.

None
None

Not associated with rulemaking

No

1
IC Title Form No. Form Name
Medicare Part B Drug and Biological Competitive Acquisition Program Applications CMS-10133 Medicare Competitive Acquisition Program

  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 12 12 0 0 0 0
Annual Time Burden (Hours) 480 480 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Bonnie Harkless 4107865666

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/17/2007


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