Competitive Acquisition Program (CAP) for Medicare Part B Drugs: CAP Physician Election Agreement

Competitive Acquisition Program (CAP) for Medicare Part B Drugs: CAP Physician Election Agreement

OMB: 0938-0987

IC ID: 8849

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Document Name
Document Type
Form and Instruction
Other-Redline
Form and Instruction
IC Document
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Competitive Acquisition Program (CAP) for Medicare Part B Drugs: CAP Physician Election Agreement
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 414.908

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10167 Competitive Acquistion Program (CAP) for Medicare Part B Drugs Cap Physician Election Agreement (Under Section 1847B of the Social Security Act) cap.osora.cms10167.FINAL.contract.doc Yes Yes Paper Only
Other-Redline cap.osora.cms10167.FINAL.redline.doc Yes Yes Paper Only

Health Health Care Services

 

3,800 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,800 0 0 -6,200 0 10,000
Annual IC Time Burden (Hours) 7,600 0 0 -12,400 0 20,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
cap cap.osora.cms10167.FINAL.crosswalk.doc 06/17/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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