Grandfathering

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

Documents and Forms

Document Name Document Type
CMS-10744.Grandfathering_Sample_Election_Letter.pdf Instruction
CMS-10744.Sample Letter - Chooses NOT to Grandfather.pdf Instruction

Information Collection (IC) Details

IC Title:	Grandfathering	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10744.Grandfathering_Sample_Election_Letter.pdf		Yes	No	Fillable Fileable
Instruction			CMS-10744.Sample Letter - Chooses NOT to Grandfather.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,106	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	270,000	270,000
Annual IC Time Burden (Hours)	31,606	31,606
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.