Application for DMEPOS Competitve Bidding Program (Form A)

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

OMB: 0938-1016

IC ID: 212256

Information Collection (IC) Details

View Information Collection (IC)

Application for DMEPOS Competitve Bidding Program (Form A)
 
No New
 
Required to Obtain or Retain Benefits
 
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 A - Application for DMEPOS Competitive Bidding Program 508_CMS-10169_Form_A.pdf Yes No Fillable Fileable Signable

Health Health Care Services

 

1,299 909
   
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 1,299 1,299 0 0 0 0
Annual IC Time Burden (Hours) 10,389 10,389 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Form A Screenshot 3 508_DBidS Form A Screenshot 3.pdf 07/07/2014
Form A Screenshot 1 508_DBidS Form A Screenshot 1.pdf 07/07/2014
Form A Screenshot 2 508_DBidS Form A Screenshot 2.pdf 07/07/2014
Form A Screenshot 4 508_DBidS Form A Screenshot 4.pdf 07/07/2014
Form A Screenshot 5 508_DBidS Form A Screenshot 5.pdf 07/07/2014
Form A Screenshot 6 508_DBidS Form A Screenshot 6.pdf 07/07/2014
Form A Screenshot 7 508_DBidS Form A Screenshot 7.pdf 07/07/2014
Form A Screenshot 8 508_DBidS Form A Screenshot 8.pdf 07/07/2014
Form A Screenshot 9 508_DBidS Form A Screenshot 9.pdf 07/07/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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