Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure

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

OMB: 0938-1016

IC ID: 203541

Information Collection (IC) Details

View Information Collection (IC)

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure
 
No Unchanged
 
Mandatory
 
42 CFR 414.422(f)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10169 Contract Suppliers Disclosure of Subcontractors 508_CMS-10169_Subcontractor_Disclosure_Form.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

390 273
   
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 390 0 0 0 0 390
Annual IC Time Burden (Hours) 160 0 0 0 0 160
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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