Information Collection Request

Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program – Contracting Forms (CMS-10744)

ICR 202011-0938-001 · OMB 0938-1408 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10744 CMS-10744.Change of Ownership Form (30-day notice) Form and Instruction New Repair queued
Form CMS-10744.Change o Change of Ownership Form and Instruction New Repair queued
Form CMS-10744 Subcontracting Disclosure Form and Instruction New Repair queued
Form CMS-10744 Subcontracting Form and Instruction New Repair queued
Form CMS-10744 Form C: Semi Annual Report Form and Instruction New Repair queued
Form CMS-10744. Form C Form C Form and Instruction New Repair queued
CMS-10744.Function Fields Updated.xlsx Supplementary Document Uploaded 2020-11-05 Repair queued
CMS-10744.SupportingStatementPartA (final).docx Supporting Statement A Uploaded 2020-11-05 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
244401 Grandfathering Instruction New
244400 Change of Ownership Form and Instruction NewCMS-10744.Change of Ownership Form (30-day notice)
244400 Change of Ownership Form and Instruction New
244399 Subcontracting Form and Instruction NewSubcontracting Disclosure
244399 Subcontracting Form and Instruction New
244398 Form C Form and Instruction NewForm C: Semi Annual Report
244398 Form C Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2023 36 Months From Approved
271,652 0 0
31,964 0 0
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Change of Ownership CMS-10744
Form C CMS-10744
Grandfathering
Subcontracting CMS-10744

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 271,652 0 0 271,652 0 0
Annual Time Burden (Hours) 31,964 0 0 31,964 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No