Application for DMEPOS Competitve Bidding Program (Form A)

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

OMB: 0938-1016

IC ID: 212256

Information Collection (IC) Details

View Information Collection (IC)

Application for DMEPOS Competitve Bidding Program (Form A)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 414.410

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction FORM A Multi Location Bidder Form A - Multi Location Bidder-508.pdf Yes Yes Fillable Fileable Signable
Form and Instruction FORM A Network Bidder Form A - Network Bidder-508.pdf Yes Yes Fillable Fileable Signable
Form and Instruction FORM A Single Location Bidder Form A - Single Location Bidder-508.pdf Yes Yes Fillable Fileable Signable
Form and Instruction FORM A Round 1-2019 R2019 Form A -508.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

500 0
   
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 500 0 0 -799 0 1,299
Annual IC Time Burden (Hours) 4,175 0 0 -6,214 0 10,389
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Form A Screenshot 3 508_DBidS Form A Screenshot 3.pdf 07/07/2014
Form A Screenshot 1 508_DBidS Form A Screenshot 1.pdf 07/07/2014
Form A Screenshot 2 508_DBidS Form A Screenshot 2.pdf 07/07/2014
Form A Screenshot 4 508_DBidS Form A Screenshot 4.pdf 07/07/2014
Form A Screenshot 5 508_DBidS Form A Screenshot 5.pdf 07/07/2014
Form A Screenshot 6 508_DBidS Form A Screenshot 6.pdf 07/07/2014
Form A Screenshot 7 508_DBidS Form A Screenshot 7.pdf 07/07/2014
Form A Screenshot 8 508_DBidS Form A Screenshot 8.pdf 07/07/2014
Form A Screenshot 9 508_DBidS Form A Screenshot 9.pdf 07/07/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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