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OMB Control No: 0938-0749	ICR Reference No: 199810-0938-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: On Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR Section 424.57
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 11/14/1998
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/31/1998
	Date Received in OIRA: 10/29/1998
Terms of Clearance: Approved for use through 6/99 under the condition that upon publication of the proposed supplier standards rule, HCFA will resubmit these forms for PRA clearance along with the underlying proposed rules. In the resubmission, HCFA must clearly crosswalk these forms with the proposed rules and describe its experience in collecting data for items such as "independent sales representatives" and "consignment closets." Finally, HCFA must explain how the on-site inspection procedures cost-effectively ensure that supplier/surveyor responses are valid and correct.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1999	09/30/1999
Responses	40,000	0	0
Time Burden (Hours)	20,000	0	0
Cost Burden (Dollars)	0	0	0

Abstract: This is used to complete information on DMEPOS suppliers' compliance with regulations found in 42 CFR section 424.57 as gathered during a visit to the physical location of the supplier upon initial enrollment or reenrollment into the Medicare program.

Emergency Justfication:

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
On Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR Section 424.57	HCFA-R-263

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	40,000	40,000
Annual Time Burden (Hours)	20,000	20,000
Annual Cost Burden (Dollars)	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $0

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

View ICR - OIRA Conclusion