Information Collection Request

Evaluation of Medicare National Competitive Bidding Program for DME

ICR 201004-0938-004 · OMB 0938-1015 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10197 CMS-10197 AppendixD-InfConsentFormsScript Form and Instruction Modified Available
Form CMS-10197 CMS-10197 AppendixC-NonstatisticalInstruments11 Form and Instruction Modified Available
Form CMS-10197 CMS-10197 AppendixD-InfConsentFormsScripts Form and Instruction Modified Available
Form CMS-10197 CMS-10197 AppendixC-NonstatisticalInstruments Form and Instruction Modified Available
Form CMS-10197 CMS-10197 Appendix B Statistical Instruments Form and Instruction Modified Available
Form CMS-10197 CMS-10197 AppendixD-InfConsentFormsScripts Form and Instruction Modified Available
Form CMS-10197 CMS-10197 AppendixD-InfConsentFormsScripts11 Form and Instruction New Available
Form CMS-10197 CMS-10197 AppendixC-NonstatisticalInstruments11_6_508ready Form and Instruction New Available
CMS-10197 PRA supporting statement 3-24-10 REDO_am.doc Supporting Statement B Uploaded 2010-04-13 Available
CMS-10197 Responsetocomments32610doc.pdf Supplementary Document Uploaded 2010-04-13 Available
CMS-10197 PRA supporting statement 3-24-10 REDO_am.doc Supporting Statement A Uploaded 2010-04-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
46620 Non-Statistical Data - Private Sector (Informant Discussions) Form and Instruction ModifiedCMS-10197 AppendixD-InfConsentFormsScript
46620 Non-Statistical Data - Private Sector (Informant Discussions) Form and Instruction ModifiedCMS-10197 AppendixC-NonstatisticalInstruments11
46619 Non-Statistical Data - Private Sector (Focus Groups) Form and Instruction ModifiedCMS-10197 AppendixD-InfConsentFormsScripts
46619 Non-Statistical Data - Private Sector (Focus Groups) Form and Instruction ModifiedCMS-10197 AppendixC-NonstatisticalInstruments
46618 Statistical Data - Households Form and Instruction ModifiedCMS-10197 Appendix B Statistical Instruments
46618 Statistical Data - Households Form and Instruction ModifiedCMS-10197 AppendixD-InfConsentFormsScripts
192613 Non-Statistical Data - Federal Government Form and Instruction NewCMS-10197 AppendixD-InfConsentFormsScripts11
192613 Non-Statistical Data - Federal Government Form and Instruction NewCMS-10197 AppendixC-NonstatisticalInstruments11_6_508ready

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2013 36 Months From Approved 05/31/2010
8,470 0 12,671
4,342 0 6,557
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Non-Statistical Data - Federal Government CMS-10197, CMS-10197 ,  
Non-Statistical Data - Private Sector (Focus Groups) CMS-10197, CMS-10197 ,  
Non-Statistical Data - Private Sector (Informant Discussions) CMS-10197, CMS-10197 ,  
Statistical Data - Households CMS-10197, CMS-10197 ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 8,470 12,671 0 -4,201 0 0
Annual Time Burden (Hours) 4,342 6,557 0 -2,215 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No