View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1016
ICR Reference No:
200701-0938-012
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Supporting Statement For Paperwork Reduction Act Submissions - Request for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program and Suppo
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
04/04/2007
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/12/2007
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2010
36 Months From Approved
Responses
39,946
0
0
Time Burden (Hours)
1,090,826
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
CMS will conduct a competitive bidding program in which certain suppliers would be awarded a contract to provide competitively priced items and services to Medicare beneficiaries. Suppliers bidding above the winning price are to be excluded from the Medicare market; however, multiple winners must be awarded in each site. Contract or winning suppliers will be picked from those suppliers bids that have the lowest bids and meet all relevant program requirements. This form will collect all relevant information needed for bidding.
Authorizing Statute(s):
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:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AN14
Final or interim final rulemaking
71 FR 25654
05/01/2006
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
71 FR 26543
05/05/2006
30-day Notice:
Federal Register Citation:
Citation Date:
71 FR 75553
12/15/2006
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
CMS-10169, CMS-10169
CMS-10169 Form D
,
CMS-10169 Form D
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
CMS-10169, CMS-10169, CMS-10169, CMS-10169, CMS-10169, CMS-10169, CMS-10169 Form B, CMS-10169 Form B, CMS-10169, CMS-10169 Form A
CMS-10169 Form A
,
CMS-10169 Form B
,
CMS-10169 Form C
,
CMS-10169 Form A
,
CMS-10169 Form A- Screenshots
,
CMS 10169 Form B
,
CMS-10169 Form B- Tab Screens
,
CMS-10169 Form B-Screen shot
,
CMS-10169
,
CMS-10169 Form A Wizard Screens
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
CMS-10169
CMS-10169
ICR Summary of Burden
Total Approved
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
39,946
0
0
39,946
0
0
Annual Time Burden (Hours)
1,090,826
0
0
1,090,826
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Changing Regulations
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Section 302(b)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173) amended section 1847 of the Social Security Act (the Act) to require the Secretary to establish and implement programs under which competitive bidding areas (CBAs) are established throughout the United States for contract award purposes for the furnishing of certain competitively priced items and services for which payment is made under Part B (the Medicare DMEPOS Competitive Bidding Program). Section 1847(a)(2) of the Act provides that the items and services to which competitive bidding applies are certain durable medical equipment (DME) and enteral nutrients, equipment and supplies (as described in section 1842(s)(2)(D) of the Act), and OTS orthotics (as described in section 1861(s)(9) of the Act) for which payment would otherwise be made under section 1834(h) of the Act and which require minimal self-adjustment). In addition, section 1847 of the Act specifies the requirements and conditions for implementation of the Medicare DMEPOS Competitive Bidding Program. Competition under the program is to be phased-in over a four-year period beginning in 2007. The competitive bidding program will be phased-in starting within 10 of the largest metropolitan statistical areas (MSAs) in 2007, 80 of the largest MSAs in 2009, and additional areas thereafter.
Annual Cost to Federal Government:
$616
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
Agency Contact:
Saleda Perryman
Common Form ICR:
No
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:
12/18/2006
An official website of the United States government
The .gov means it's official.
The site is secure.
