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Federal forms, ICRs, and supporting documents

Information Collection

Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

IC 46761 under ICR 200701-0938-012 · OMB 0938-1016.

Documents and Forms
Document Name
Document Type
Form
Instruction
Instruction
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10169 CMS-10169 Form A CMS-10169A (2).pdf Yes Yes Fillable Fileable
Form CMS-10169 CMS-10169 Form B CMS-10169B.pdf Yes Yes Fillable Fileable
Form CMS-10169 CMS-10169 Form C CMS-10169C (2).pdf Yes Yes Fillable Fileable
Instruction CMS-10169.Instructions.doc Yes No Paper Only
Form CMS-10169 CMS-10169 Form A CMS-10169.Form A.pdf Yes Yes Fillable Fileable
Form CMS-10169 CMS 10169 Form B CMS-10169.Form B.pdf Yes Yes Fillable Fileable
Form CMS-10169 CMS-10169 Form A- Screenshots CMS-10169.Form A - screen shots.doc Yes Yes Fillable Fileable
Form CMS-10169 CMS-10169 CMS-10169.Form C.pdf Yes Yes Fillable Fileable
Instruction CMS-10169 MASTER Instructions-3-27-07.doc Yes No Paper Only
Form CMS-10169 Form A CMS-10169 Form A Wizard Screens CMS.10169.Form A Wizard Screens.doc Yes Yes Fillable Fileable
Form CMS-10169 Form B CMS-10169 Form B- Tab Screens CMS-10169.Form B Tab Screens.doc Yes Yes Fillable Fileable
Form CMS-10169 Form B CMS-10169 Form B-Screen shot CMS-10169.Form B Wizard Screens.doc Yes Yes Fillable Fileable

Health Health Care Services

 

15,973 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 15,973 0 15,973 0 0 0
Annual IC Time Burden (Hours) 1,086,164 0 1,086,164 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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