Information Collection

Bidding Form (Form B)

IC 212257 under ICR 202512-0938-005 · OMB 0938-1016.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10169 Form B _ Bidding Form Bidding Form (Form B)	Form and Instruction
Form Form B Certification Bidding Form (Form B)	Form and Instruction
Form Form B Create Bid Bidding Form (Form B)	Form and Instruction
Form Form B Manufacturer Bidding Form (Form B)	Form and Instruction
Form Form B Manufacturer, Model Name, and Number Bidding Form (Form B)	Form and Instruction
Form Form B Bid Sheet Bidding Form (Form B)	Form and Instruction
Form CMS-10169 Form B _ Bidding Form Bidding Form (Form B)	Form and Instruction
Form Form B Certification Bidding Form (Form B)	Form and Instruction
Form Form B Create Bid Bidding Form (Form B)	Form and Instruction
Form Form B Manufacturer Bidding Form (Form B)	Form and Instruction
Form Form B Manufacturer, Model Name, and Number Bidding Form (Form B)	Form and Instruction
Form Form B Bid Sheet Bidding Form (Form B)	Form and Instruction
CMS-10169 Form B _ Bidding Form Form B Bid sheet_future.jpg	Form and Instruction
CMS-10169 Form B _ Bidding Form Form B Bid sheet_future.jpg	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
Form B Bid Sheet Proposed Form B - Bid Sheet.pdf	Form and Instruction
Form B Bid Sheet Proposed Form B - Bid Sheet.pdf	Form and Instruction
Form B Crosswalk_05202025.xlsx Crosswalk: Form B	IC Document
Form B Crosswalk_05202025.xlsx Crosswalk: Form B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Bidding Form (Form B)

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	CMS-10169	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
Form and Instruction	Form B	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

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
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,000	-16,500	17,500
Annual IC Time Burden (Hours)	1,200	-51,300	52,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk: Form B		06/04/2026

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].