Suppliers that Choose Not to Grandfather - Round 1 Recompete (30-Day Notification to Beneficiary)

Grandfathering Provisions of the Medicare DMEPOS Competitive Bidding Program

Documents and Forms

Document Name Document Type
Form CMS-10309 Suppliers that Choose Not to Grandfather - Round 1 Recompete (30-Day Notification to Beneficiary) Form
CMS-10309 Grandfather Non-Election Letter R12017_Grandfathering_Sample_Non-election_Letter.pdf Form

Information Collection (IC) Details

IC Title:	Suppliers that Choose Not to Grandfather - Round 1 Recompete (30-Day Notification to Beneficiary)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.408(j)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10309	Grandfather Non-Election Letter	R12017_Grandfathering_Sample_Non-election_Letter.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 102	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,996	8,348	1,648
Annual IC Time Burden (Hours)	855	709	146
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.