Grandfathering Provisions of the Medicare DMEPOS Competitive Bidding Program in the Physician Fee Schedule and Other Revisions to Part B for CY 2010

Forms and Documents

Document Name	Status
CMS-10309.Supporting Statement Part A.doc Supporting Statement A	2009-12-01

IC Document Collections

IC ID	Document Title	Status
191550	Suppliers that Choose to Grandfather (Submission of 30-day Notification to Beneficiaries)	New
191549	Suppliers that Choose to Grandfather (Development of 30-day Notification to Beneficiaries)	New
191548	Suppliers that Choose to Grandfather (Development and Submission of 30-day Notification to CMS)	New
191547	Suppliers that Choose Not to Grandfather (30-day Notifications to Beneficiaries)	New
191546	Suppliers that Choose Not to Grandfather (Development of 30-day Notifications to Beneficiaries)	New
191545	Suppliers that Choose Not to Grandfather (10 and 2-day Notifications to Beneficiaries)	New

ICR Details

OMB Control No: 0938-1079	ICR Reference No: 200912-0938-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Grandfathering Provisions of the Medicare DMEPOS Competitive Bidding Program in the Physician Fee Schedule and Other Revisions to Part B for CY 2010
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 without change	Conclusion Date: 01/26/2010
	Date Received in OIRA: 12/12/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	36 Months From Approved
Responses	85,695	0	0
Time Burden (Hours)	28,456	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection covers the notices suppliers must provide to CMS and beneficiaries of their intention to be a grandfathered DMEPOS supplier for certain items.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 302(b)(1) Name of Law: Competitive Acquisition
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP40	Final or interim final rulemaking	74 FR 61738	11/25/2009

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 33520	07/13/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 61738	11/25/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Suppliers that Choose to Grandfather (Development and Submission of 30-day Notification to CMS)
Suppliers that Choose to Grandfather (Development of 30-day Notification to Beneficiaries)
Suppliers that Choose to Grandfather (Submission of 30-day Notification to Beneficiaries)
Suppliers that Choose Not to Grandfather (Development of 30-day Notifications to Beneficiaries)
Suppliers that Choose Not to Grandfather (30-day Notifications to Beneficiaries)
Suppliers that Choose Not to Grandfather (10 and 2-day Notifications to Beneficiaries)

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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	85,695	0	0	85,695	0	0
Annual Time Burden (Hours)	28,456	0	0	28,456	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: This is a new information collection.

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Annual Cost to Federal Government: $120,000

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)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 12/12/2009

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