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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form A Business Organization	Form and Instruction	Modified	Available
Form Form A Form A: Application for DMEPOS Competitve Bidding Program	Form and Instruction	Modified	Available
Form Form B Bid Sheet	Form and Instruction	Modified	Available
Form Form B Manufacturer, Model Name, and Number	Form and Instruction	Modified	Available
Form Form B Manufacturer	Form and Instruction	Modified	Available
Form Form B Create Bid	Form and Instruction	Modified	Available
Form Form B Certification	Form and Instruction	Modified	Available
Form CMS-10169 Form B _ Bidding Form	Form and Instruction	Modified	Available
CMS-10169 - Supporting_Statement_Part_A to OSORA 06.04.26 (2026 version 12) CLEAN final.docx	Supporting Statement A	Uploaded 2026-06-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
232396	Form A: Application for DMEPOS Competitve Bidding Program	Form and Instruction	Modified	Business Organization
232396	Form A: Application for DMEPOS Competitve Bidding Program	Form and Instruction	Modified	Form A: Application for DMEPOS Competitve Bidding Program
212257	Bidding Form (Form B)	Form and Instruction	Modified	Bid Sheet
212257	Bidding Form (Form B)	Form and Instruction	Modified	Manufacturer, Model Name, and Number
212257	Bidding Form (Form B)	Form and Instruction	Modified	Manufacturer
212257	Bidding Form (Form B)	Form and Instruction	Modified	Create Bid
212257	Bidding Form (Form B)	Form and Instruction	Modified	Certification
212257	Bidding Form (Form B)	Form and Instruction	Modified	Form B _ Bidding Form

ICR Details

OMB Control No: 0938-1016	ICR Reference No: 202512-0938-005
Status: Received in OIRA	Previous ICR Reference No: 201812-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CMS-10169)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/04/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	1,500	0
Time Burden (Hours)	2,750	0
Cost Burden (Dollars)	0	0

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Abstract: CMS is seeking approval to reinstate the Information Collection Request (ICR) and to update our burden estimates to Forms A and B in preparation for the next round. CMS will publish a slightly modified version of Form A so that bidders will be better able to identify and understand the new requirement related to bid surety bonds (Section 1847(a)(1)(G) of the Act, added by section 522(a) of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10) (MACRA). We have made changes to Form B to remove the expansion plan section and to include the bidding methodology proposed in CMS-1691-P (83 FR 34304).

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Authorizing Statute(s): PL: Pub.L. 111 - 148 6410 Name of Law: Adjustments to the Medicare DMEPOS competitive acquisition program
   PL: Pub.L. 114 - 10 522 Name of Law: Requiring bid surety bonds for bidding entities
   PL: Pub.L. 110 - 275 154 Name of Law: Delay in and Reform of Medicare DMEPOS Competitive Acquisition Program
   PL: Pub.L. 108 - 173 302(b)(1) Name of Law: Payment for durable medical equipment; competitive acquisition of certain items and services
  

Citations for New Statutory Requirements: PL: Pub.L. 108 - 173 302(b)(1) Name of Law: Payment for durable medical equipment; competitive acquisition of certain items and services
PL: Pub.L. 110 - 275 154 Name of Law: Delay in and Reform of Medicare DMEPOS Competitive Acquisition Program
PL: Pub.L. 111 - 148 6410 Name of Law: Adjustments to the Medicare DMEPOS competitive acquisition program
PL: Pub.L. 114 - 10 522 Name of Law: Requiring bid surety bonds for bidding entities

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV63	Final or interim final rulemaking	90 FR 55342	12/02/2025

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 29108	05/02/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 55342	12/02/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Bidding Form (Form B)	Form B, Form B, Form B, Form B, Form B, CMS-10169	Form B _ Bidding Form ,   Certification ,   Create Bid ,   Manufacturer ,   Manufacturer, Model Name, and Number ,   Bid Sheet
Form A: Application for DMEPOS Competitve Bidding Program	Form A, Form A	Form A: Application for DMEPOS Competitve Bidding Program ,   Business Organization

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	1,500	0	0	-16,500	0	18,000
Annual Time Burden (Hours)	2,750	0	0	-53,925	0	56,675
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Numerous variables can impact burden and may be unique to each round of the Medicare DMEPOS CBP. Variables contributing to burden differences between rounds include the number of product categories in the round, resulting in the number of bidders and the number of bids submitted. Rulemaking can also contribute to burden differences between rounds. The total overall burden for this package has decreased as a result of several proposals outlined in this Notice of Final Rulemaking.

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Annual Cost to Federal Government: $1,500,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/04/2026

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