DESCRIPTION OF FORM C NON-SUBSTANTIVE CHANGE_Final (August 2015)

DESCRIPTION OF NON-SUBSTANTIVE CHANGE TO OMB CONTROL #0938-1016
The Centers for Medicare & Medicaid Services (CMS) has identified a non-substantive change to the
previously approved Form C (CMS-10169) for the Durable Medical Equipment, Prosthetics, Orthotics,
and Supplies (DMEPOS) Competitive Bidding Program information collection (OMB # 0938-1016).
Form C (CMS-10169):
Collection via Form C collects prospective information on the brands of products durable medical
equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers intend to offer to Medicare
beneficiaries during the upcoming quarter. The form is completed each quarter (January, April, July, and
October) to either update product brand information or to verify that there is no change in the brands of
product that will be offered to Medicare beneficiaries. The information submitted by each contract
supplier on Form C is posted on the Internet to help customer services representatives at 1-800MEDICARE, clinicians, beneficiaries, and caregivers locate contract suppliers that furnish specific
products. A considerable number of resources—an estimated 660 hours—are dedicated to Form C
processing each quarter. Furthermore, research indicates that suppliers rarely update their listings each
quarter (90% of suppliers retain the same information every quarter).
As a result, we will be changing our quarterly requirement to a semi-annual submission (January and
July), effective July 1, 2016. This change would constitute a decrease in burden to contract suppliers and
would reduce the amount of resources and costs to the government that is required to operationalize
the Form C requirement.
We are requesting approval of this non-substantive change by October 1, 2015.