Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application for DMEPOS Competitve Bidding Program (Form A) Removed 0 0 0 Form and Instruction CMS-10169
Bidding Form (Form B) Modified 17500 52500 0 Form and Instruction CMS-10169
Change of Ownership (CHOW) - Purchaser Form Removed 0 0 0 Form and Instruction CMS-10169
Change of Ownership (CHOW) Contract Supplier Notification Form Removed 0 0 0 Form and Instruction CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C) Removed 0 0 0 Form and Instruction CMS-10169
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure Removed 0 0 0 Form and Instruction CMS-10169
Form A: Application for DMEPOS Competitve Bidding Program Modified 500 4175 0 Form and Instruction CMS-10169
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Removed 0 0 0 Form and Instruction CMS-10169
Form and Instruction CMS-10169
Total burden requested under this ICR: 18000 56675 0  
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