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:
201703-0938-014
Status:
Historical Inactive
Previous ICR Reference No:
201701-0938-004
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CMS-10169
Title:
Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Withdrawn and continue
Conclusion Date:
04/05/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/23/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2017
36 Months From Approved
05/07/2018
Responses
36,997
0
36,997
Time Burden (Hours)
234,194
0
234,194
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:
81 FR 71100
10/14/2016
30-day Notice:
Federal Register Citation:
Citation Date:
82 FR 5578
01/18/2017
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
6
IC Title
Form No.
Form Name
Subcontracting Disclosure
CMS-10169
Subcontracting Disclosure
Application for DMEPOS Competitve Bidding Program (Form A)
FORM A, FORM A, FORM A, FORM A
Multi Location Bidder
,
Network Bidder
,
Single Location Bidder
,
Round 1-2019
Bidding Form (Form B)
FORM B
Bidding Form
Change of Ownership (CHOW) - Purchaser Form
CMS-10169
Change of Ownership - Purchaser Form - 30-day notice
Change of Ownership (CHOW) Forms-60-day & 30-day notices
CMS-10169, CMS-10169
CHOW 30-day Notice (Change of Ownership Form)
,
CHOW 30-day Notice (Change of Ownership Form)
Form C-Semi Annual Report Screen Shot
FORM C, FORM C, FORM C
SEMI ANNUAL Report e-signature
,
Semi Annual Report Screen Shot 1
,
Semi Annual Report Screen Shot 2
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)
FORM D, FORM D
Beneficiary Survey-English Version
,
Beneficiary Survey-Spanish Version
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:
The previous ICR reflected additional burden for Forms A and B because information had to be collected for Round 1 2017, Round 2 Recompete and the national mail-order recompete. This information has already been collected and therefore is not applicable for this ICR. Information collection for these forms will be applicable when bidding begins for Round 2019. In this ICR, the annual burden for Form A for Round 2019 is 500 responses and 4,175 hours. The annual burden for Form B for Round 2019 is 11,500 responses and 138,000 hours. A decreases in burden associated with these forms represent the consolidation of all CBAs into Round 2019 and more accurate estimates based on our experience from prior rounds of competition.
Annual Cost to Federal Government:
$2,798,264
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
Kayla Williams 410 786-5887 Kayla.Williams@cms.hhs.gov
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:
03/23/2017
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