View Information Collection Request (ICR) Package
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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:
201411-0938-001
Status:
Historical Active
Previous ICR Reference No:
201407-0938-008
Agency/Subagency:
HHS/CMS
Agency Tracking No:
19556
Title:
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
11/13/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/03/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2017
09/30/2017
09/30/2017
Responses
39,455
0
39,455
Time Burden (Hours)
235,014
0
235,014
Cost Burden (Dollars)
0
0
0
Abstract:
The Medicare DMEPOS Competitive Bidding Program was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("Medicare Modernization Act" or "MMA"). Section 302 of the MMA amended Section 1847 of the Social Security Act to establish the competitive acquisition program and define program requirements. The most recent approval for this information collection request (ICR) was issued by OMB on June 10, 2013. That ICR included the estimated burden to collect the information in bidding Forms A and B for the Round 1 Recompete. We are now seeking approval to collect the information in Forms A and B for competitions that will occur before 2017.
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
PL:
Pub.L. 110 - 275 154
Name of Law: Delay in and Reform of Medicare DMEPOS Competitive Acquisition Program
Citations for New Statutory Requirements:
PL: Pub.L. 110 - 275 154 Name of Law: Delay in and Reform of Medicare DMEPOS Competitive Acquisition Program
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 21932
04/18/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 38033
07/03/2014
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
7
IC Title
Form No.
Form Name
Application for DMEPOS Competitve Bidding Program (Form A)
CMS-10169
Form A
Bidding Form (Form B)
CMS-10169
Form B _ Bidding Form
Change of Ownership (CHOW) - Purchaser Form
CMS-10169
Change of Ownership - Purchaser Form - 30-day notice
Change of Ownership (CHOW) Contract Supplier Notification Form
CMS-10169
Change of Ownership - Contract Supplier Notificaiton Form - 60-day Notice
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C)
CMS-10169
Quarterly Report
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure
CMS-10169
Contract Suppliers Disclosure of Subcontractors
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)
CMS-10169, CMS-10169
Beneficiary Survey (English Language Version)
,
Beneficiary Survey (Spanish Language Version)
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
39,455
39,455
0
0
0
0
Annual Time Burden (Hours)
235,014
235,014
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
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:
$2,310,864
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]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
William Parham 4107864669
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:
11/03/2014
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