Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

OMB: 0938-1016

IC ID: 203540

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

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Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)
 
No Removed
 
Voluntary
 
42 CFR 414.410

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10169 Beneficiary Survey (English Language Version) 508_CMS-10169_Form D_ English.pdf Yes Yes Fillable Fileable Signable
Form and Instruction CMS-10169 Beneficiary Survey (Spanish Language Version) 508_CMS-10169_Form_D_Spanish.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

14,667 0
   
Individuals or Households
 
   100 %

  Approved 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 0 0 -14,667 0 0 14,667
Annual IC Time Burden (Hours) 0 0 -7,333 0 0 7,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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