Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)

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

OMB: 0938-1016

IC ID: 203540

Information Collection (IC) Details

View Information Collection (IC)

Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)
 
No Modified
 
Voluntary
 
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 Beneficiary Survey Form D_2012.docx Yes Yes Fillable Fileable

Health Health Care Services

 

14,667 0
   
Individuals or Households
 
   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 14,667 0 0 0 0 14,667
Annual IC Time Burden (Hours) 7,333 0 0 0 0 7,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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