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Federal forms, ICRs, and supporting documents

Information Collection

Medicare Part B Drug and Biological Competitive Acquisition Program Applications

IC 43673 under ICR 200906-0938-012 · OMB 0938-0955.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Track Change Document
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Medicare Part B Drug and Biological Competitive Acquisition Program Applications
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 414.910

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Track Change Document cap.osora.cms10133.2009.revised_2009_Vendor_ApplicationREDLINE_IN COMMENTS-508-030309.doc Yes Yes Paper Only
Form and Instruction CMS-10133 Medicare Competitive Acquisition Program cap.osora.cms10133.2009.submitted.revised_2009_Vendor_ApplicationFNL-508-030209.pdf Yes Yes Paper Only

Health Health Care Services

 

10 0
   
Private Sector Businesses or other for-profits
 
   50 %

  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 10 0 0 -2 0 12
Annual IC Time Burden (Hours) 1 0 0 -479 0 480
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.