Information Collection

Form B: Bidding Form

IC 212257 under ICR 202507-0938-015 · OMB 0938-1016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form B Form B: Bidding Form	Form and Instruction
Form Form B Bid Sheet Form B: Bidding Form	Form and Instruction
Form Form B Certification Form B: Bidding Form	Form and Instruction
Form Form B Create Bid Form B: Bidding Form	Form and Instruction
Form Form B Manufacturer Form B: Bidding Form	Form and Instruction
Form Form B Manufacturer, Model Name, and Number Form B: Bidding Form	Form and Instruction
Form B Bid Sheet 508_CMS-10169_Form_B.pdf	Form and Instruction
Form B Bid Sheet 508_CMS-10169_Form_B.pdf	Form and Instruction
Form B Certification Proposed Form B - Certification (No Changes).pdf	Form and Instruction
Form B Certification Proposed Form B - Certification (No Changes).pdf	Form and Instruction
Form B Create Bid Proposed Form B - Create Bid (No Changes).pdf	Form and Instruction
Form B Create Bid Proposed Form B - Create Bid (No Changes).pdf	Form and Instruction
Form B Manufacturer Proposed Form B - Manufacturer (No Changes).pdf	Form and Instruction
Form B Manufacturer Proposed Form B - Manufacturer (No Changes).pdf	Form and Instruction
Form B Manufacturer, Model Name, and Number Proposed Form B - Manufacturer, Model Name and Number (No Changes).pdf	Form and Instruction
Form B Manufacturer, Model Name, and Number Proposed Form B - Manufacturer, Model Name and Number (No Changes).pdf	Form and Instruction
508 Compliant Form B - Crosswalk.pdf Form B: Crosswalk	IC Document
508 Compliant Form B - Crosswalk.pdf Form B: Crosswalk	IC Document

IC Title:

Form B: Bidding Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 414.410

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form B	Yes	Yes	Fillable Fileable Signable
Form and Instruction	Form B	Yes	Yes	Fillable Fileable
Form and Instruction	Form B	Yes	Yes	Fillable Fileable
Form and Instruction	Form B	Yes	Yes	Fillable Fileable
Form and Instruction	Form B	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 350

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	37,833	20,333	17,500
Annual IC Time Burden (Hours)	42,834	-9,666	52,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form B: Crosswalk		07/10/2025

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].