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

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.