DME Suppliers Web-Based Survey

QIC Demonstration Evaluation Contractor (QDEC): Analyze Medicare Appeals to Conduct Formal Discussions and Reopenings with DME Suppliers and Part A Providers (CMS-10633)

OMB: 0938-1348

IC ID: 227305

Information Collection (IC) Details

View Information Collection (IC)

DME Suppliers Web-Based Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10633 Web Based Surveys QDEC-Attachment A-WebBasedSurvey_508compliant.pdf Yes Yes Fillable Fileable
Form CMS-10633 DME Survey Screenshots QDEC_Attachment D DME survey screenshots.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,544 1,524
   
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 2,544 0 0 4 0 2,540
Annual IC Time Burden (Hours) 425 0 0 2 0 423
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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