Information Collection Request

Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

ICR 201207-0938-007 · OMB 0938-1016 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10169 CMS-10169.RFB Form B Form and Instruction Removed Available
Form CMS-10169 CMS-10169.RFB Form A Form and Instruction Removed Available
Form CMS-10169 CMS-10169.RFB Form C Form and Instruction Removed Available
Form CMS-10169 Subcontracting Disclosure Form Form and Instruction New Source copy available
Form CMS-10169 Beneficiary Survey Form and Instruction New Repair queued
Form CMS-10169 Form C Quarterly Report Form and Instruction New Available
Form CMS-10169 Form B - Bidding Form Form and Instruction New Available
Form CMS-10169 Application for Suppliers Form and Instruction New Available
Form CMS-10169 CMS-10169.REVISED RFB Form D Form and Instruction Removed Available
60-Day Comment Response for PRA CMS-10169.docx Supplementary Document Uploaded 2012-07-25 Available
Form B-6.jpg Supplementary Document Uploaded 2012-07-25 Available
Form B-5.jpg Supplementary Document Uploaded 2012-07-25 Available
Form B-4.jpg Supplementary Document Uploaded 2012-07-25 Available
Form B-3.jpg Supplementary Document Uploaded 2012-07-25 Repair queued
Form B-2.jpg Supplementary Document Uploaded 2012-07-25 Available
Form B-1.jpg Supplementary Document Uploaded 2012-07-25 Available
6-cbas and product categories Screen View.JPG Supplementary Document Uploaded 2012-07-25 Available
5-additional locations Screen View.JPG Supplementary Document Uploaded 2012-07-25 Available
4-add location Screen View.JPG Supplementary Document Uploaded 2012-07-25 Available
3-CBAs and Product Categories Screen View.JPG Supplementary Document Uploaded 2012-07-25 Repair queued
2-Location Specific Information Screen View.JPG Supplementary Document Uploaded 2012-07-25 Available
1-Business Org Screen View.JPG Supplementary Document Uploaded 2012-07-25 Available
1 Network Business Org Screen View.JPG Supplementary Document Uploaded 2012-07-25 Available
CMS-10169.Crosswalks for Form A.xlsx Supplementary Document Uploaded 2012-07-25 Available
CMS-10169 Supporting Statement Part A - 2012.docx Supporting Statement A Uploaded 2012-07-25 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
46761 Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (Forms A, B, C) Form and Instruction RemovedCMS-10169.RFB Form B
46761 Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (Forms A, B, C) Form and Instruction RemovedCMS-10169.RFB Form A
46761 Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (Forms A, B, C) Form and Instruction RemovedCMS-10169.RFB Form C
203541 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure Form and Instruction NewSubcontracting Disclosure Form
203540 Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Form and Instruction NewBeneficiary Survey
203539 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C) Form and Instruction NewForm C Quarterly Report
203538 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Bidding Form (Form B) Form and Instruction NewForm B - Bidding Form
203537 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Application for Suppliers (Form A) Form and Instruction NewApplication for Suppliers
189665 Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (Subcontracting) Removed
189664 Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (Form D) Form and Instruction RemovedCMS-10169.REVISED RFB Form D

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2015 36 Months From Approved 10/31/2012
16,865 0 10,100
34,795 0 443,400
0 0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Application for Suppliers (Form A) CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Bidding Form (Form B) CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C) CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure CMS-10169
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (Form D) CMS-10169
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (Forms A, B, C) CMS-10169, CMS-10169, CMS-10169 ,   ,  
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (Subcontracting)
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) CMS-10169

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 16,865 10,100 0 6,765 0 0
Annual Time Burden (Hours) 34,795 443,400 0 -408,605 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No