Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C)

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

OMB: 0938-1016

IC ID: 203539

Information Collection (IC) Details

View Information Collection (IC)

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C)
 
No Modified
 
Mandatory
 
42 CFR 414.410

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10169 Form C: QUARTERLY REPORT Form C screenshot FINAL-SuppDirConceptv2Default.pdf No No Fillable Fileable

Health Health Care Services

 

1,238 867
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,952 0 3,528 0 0 1,424
Annual IC Time Burden (Hours) 1,651 0 1,177 0 0 474
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk - Form C: Quarterly Report Crosswalk for Changes to Form C.docx 05/10/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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