Medicare Part B Drug and Biological Competitive Acquisition Program Applications

Documents and Forms

Document Name Document Type
Form CMS-10133 Medicare Part B Drug and Biological Competitive Acquisition Program Applications Form and Instruction
cap.osora.cms10133.2009.revised_2009_Vendor_ApplicationREDLINE_IN COMMENTS-508-030309.doc Other-Track Change Document
CMS-10133 Medicare Competitive Acquisition Program cap.osora.cms10133.2009.submitted.revised_2009_Vendor_ApplicationFNL-508-030209.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Part B Drug and Biological Competitive Acquisition Program Applications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 414.910

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	-2	12
Annual IC Time Burden (Hours)	1	-479	480
Annual IC Cost Burden (Dollars)	0	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.