Information Collection

Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation

IC 37897 under ICR 201001-0938-001 · OMB 0938-0679.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0679 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-847 CMS-847 -- OSTEOGENESIS STIMULATORS Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Form and Instruction
Form CMS-846 CMS-846 -- PNEUMATIC COMPRESSION DEVICES Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Form and Instruction
Form CMS-848 CMS-848 -- TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (TENS) Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Form and Instruction
Form CMS-849 CMS-849 -- SEAT LIFT MECHANISMS Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Form and Instruction
Form CMS-854 CMS-854 -- CONTINUATION FORM Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Form and Instruction
Form CMS-10125 CMS-10125 -- EXTERNAL INFUSION PUMPS Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Form and Instruction
Form CMS-10126 CMS-10126 -- ENTERAL AND PARENTERAL NUTRITION Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Form and Instruction
Form CMS-10269 CMS-10269: POSITIVE AIRWAY PRESSURE (PAP) DEVICES FOR OBSTRUCTIVE SLEEP APNEA Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Form and Instruction
CMS-847 CMS-847 -- OSTEOGENESIS STIMULATORS CMS847.pdf	Form and Instruction
CMS-846 CMS-846 -- PNEUMATIC COMPRESSION DEVICES CMS846.pdf	Form and Instruction
CMS-848 CMS-848 -- TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (T CMS848.pdf	Form and Instruction
CMS-849 CMS-849 -- SEAT LIFT MECHANISMS CMS849.pdf	Form and Instruction
CMS-854 CMS-854 -- CONTINUATION FORM CMS854.pdf	Form and Instruction
CMS-10125 CMS-10125 -- EXTERNAL INFUSION PUMPS CMS10125.pdf	Form and Instruction
CMS-10126 CMS-10126 -- ENTERAL AND PARENTERAL NUTRITION CMS10126.pdf	Form and Instruction
CMS-10269 CMS-10269: POSITIVE AIRWAY PRESSURE (PAP) DEVICES FOR OB CMS-10269.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-847	Yes	No	Fillable Fileable
Form and Instruction	CMS-846	Yes	No	Fillable Fileable
Form and Instruction	CMS-848	Yes	No	Fillable Fileable
Form and Instruction	CMS-849	Yes	No	Fillable Fileable
Form and Instruction	CMS-854	Yes	No	Fillable Fileable
Form and Instruction	CMS-10125	Yes	No	Fillable Fileable
Form and Instruction	CMS-10126	Yes	No	Fillable Fileable
Form and Instruction	CMS-10269	Yes	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,480,000	6,480,000
Annual IC Time Burden (Hours)	1,296,000	1,296,000
Annual IC Cost Burden (Dollars)	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.

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