Medicare Program: Conditions of Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles

(CMS-10116) Medicare Program: Conditions of Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0971 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Medicare Program: Conditions of Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 410.38(c)(2)(iii)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 46,000	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	72,500	-101,310	173,810
Annual IC Time Burden (Hours)	16,917	-17,845	34,762
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.