Change of Ownership (CHOW) - Purchaser Form

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

OMB: 0938-1016

IC ID: 206873

Information Collection (IC) Details

View Information Collection (IC)

Change of Ownership (CHOW) - Purchaser Form
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10169 Change of Ownership - Purchaser Form - 30-day notice 508_CMS-10169_CHOW_30_Day.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

122 81
   
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 111 0 0 0 0 111
Annual IC Time Burden (Hours) 111 0 0 0 0 111
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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