Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Subcontracting Disclosure Modified 516 165 0 Form and Instruction CMS-10169 Subcontracting Disclosure
Application for DMEPOS Competitve Bidding Program (Form A) Modified 500 4175 0 Form and Instruction FORM A Multi Location Bidder
Form and Instruction FORM A Network Bidder
Form and Instruction FORM A Single Location Bidder
Form and Instruction FORM A Round 1 -2019
Bidding Form (Form B) Modified 12000 138000 0 Form and Instruction FORM B Bidding Form
Change of Ownership (CHOW) - Purchaser Form Removed 0 0 0 Form and Instruction CMS-10169 Change of Ownership - Purchaser Form - 30-day notice
Change of Ownership (CHOW) Forms-60-day & 30-day notices Modified 92 169 0 Form and Instruction CMS-10169 CHOW 60-day Notice(Change of Ownership Form)
Form and Instruction CMS-10169 CHOW 30-day Notice(Change of Ownership Form)
Form C-Semi Annual Report Screen Shot Modified 3188 625 0 Form and Instruction FORM C Semi Annual Report
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Modified 21200 10600 0 Form and Instruction FORM D Beneficiary Survey-English Version
Form and Instruction FORM D Beneficiary Survey-Spanish Version
Total burden requested under this ICR: 37496 153734 0  
To view an IC, click on IC Title