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Federal forms, ICRs, and supporting documents

Information Collection

Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation

IC 37897 under ICR 202002-0938-014 · OMB 0938-0679.

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

View Information Collection (IC)

Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10126 CMN for ENTERAL AND PARENTERAL NUTRITION CMS-10126 - CMN ENTERAL AND PARENTERAL NUTRITION.pdf Yes No Fillable Fileable Signable
Form and Instruction CMS-854 CMS-854 -- CONTINUATION FORM CMS-854 - CONTINUATION FORM.pdf Yes No Fillable Fileable
Form and Instruction CMS-846 CMS for PNEUMATIC COMPRESSION DEVICES CMS-846 - PNEUMATIC COMPRESSION DEVICES.pdf Yes No Fillable Fileable Signable
Form and Instruction CMS-847 CMN for OSTEOGENESIS STIMULATORS CMS-847 - OSTEOGENESIS STIMULATORS.pdf Yes No Fillable Fileable Signable
Form and Instruction CMS-848 CMN for TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (TENS) CMS-848 - TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (TENS).pdf Yes No Fillable Fileable Signable
Form and Instruction CMS-849 CMN for SEAT LIFT MECHANISMS CMS-849 - SEAT LIFT MECHANISMS.pdf Yes No Fillable Fileable Signable
Form and Instruction CMS-10125 CMN for EXTERNAL INFUSION PUMPS CMS-10125 - EXTERNAL INFUSION PUMPS.pdf Yes No Fillable Fileable Signable

Health Health Care Services

 

59,200 0
   
Private Sector Businesses or other for-profits
 
   90 %

  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 259,597 0 0 -202,403 0 462,000
Annual IC Time Burden (Hours) 51,919 0 0 -40,481 0 92,400
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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