Information Collection Request

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CMS-10169)

ICR 202507-0938-015 · OMB 0938-1016 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form A Application for DMEPOS Competitve Bidding Program Form and Instruction Modified Available
Form Form A Form A: Application for DMEPOS Competitve Bidding Program Form and Instruction Modified Repair queued
Form Form B Manufacturer, Model Name, and Number Form and Instruction Modified Repair queued
Form Form B Manufacturer Form and Instruction Modified Repair queued
Form Form B Create Bid Form and Instruction Modified Repair queued
Form Form B Certification Form and Instruction Modified Available
Form Form B Bid Sheet Form and Instruction Modified Available
Form Form B Form B: Bidding Form Form and Instruction Modified Repair queued
CMS-10169_Supporting_Statement_Part_A - (CMS-1828-P version 6).docx Supporting Statement A Uploaded 2025-07-10 Available
CMS-10169_Supporting_Statement_Part_A - (CMS-1828-P version 6).docx Supporting Statement A Uploaded 2025-07-10 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
232396 Form A: Application for DMEPOS Competitve Bidding Program Form and Instruction ModifiedApplication for DMEPOS Competitve Bidding Program
232396 Form A: Application for DMEPOS Competitve Bidding Program Form and Instruction Modified
212257 Form B: Bidding Form Form and Instruction ModifiedManufacturer, Model Name, and Number
212257 Form B: Bidding Form Form and Instruction ModifiedManufacturer
212257 Form B: Bidding Form Form and Instruction ModifiedCreate Bid
212257 Form B: Bidding Form Form and Instruction ModifiedCertification
212257 Form B: Bidding Form Form and Instruction ModifiedBid Sheet
212257 Form B: Bidding Form Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Form A: Application for DMEPOS Competitve Bidding Program Form A
Form B: Bidding Form Form B, Form B, Form B, Form B, Form B ,   ,   ,   ,  



Reginfo record details
  No