Subcontracting Disclosure

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

OMB: 0938-1016

IC ID: 203541

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Subcontracting Disclosure
 
No Modified
 
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 Subcontracting Disclosure Connexion - Subcontractor.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

516 372
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested 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 516 0 0 126 0 390
Annual IC Time Burden (Hours) 165 0 0 5 0 160
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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