Form C-Semi Annual Report Screen Shot

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1016 can be found here:

Documents and Forms

Document Name Document Type
Form FORM C Form C-Semi Annual Report Screen Shot Form
FORM C SEMI ANNUAL Report e-signature Connexion - Form C_esignature.pdf Form
FORM C Semi Annual Report Screen Shot 1 Connexion - Form C1.pdf Form and Instruction
FORM C Semi Annual Report Screen Shot 2 Connexion - Form C2.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Form C-Semi Annual Report Screen Shot	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.410

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FORM C	SEMI ANNUAL Report e-signature	Connexion - Form C_esignature.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FORM C	Semi Annual Report Screen Shot 1	Connexion - Form C1.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FORM C	Semi Annual Report Screen Shot 2	Connexion - Form C2.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,594	Number of Respondents for Small Entity: 1,116

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,188	694	2,494
Annual IC Time Burden (Hours)	625	-206	831
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.