OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR Section 424.57

ICR 199906-0938-001 · OMB 0938-0749 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
8452 On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR Section 424.57 Form Migrated
ICR Details
0938-0749 199906-0938-001
Historical Active 199810-0938-006
HHS/CMS
On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR Section 424.57
Revision of a currently approved collection   No
Regular
Approved without change 07/30/1999
Retrieve Notice of Action (NOA) 06/02/1999
  Inventory as of this Action Requested Previously Approved
07/31/2002 07/31/2002 09/30/1999
40,000 0 40,000
20,000 0 20,000
0 0 0
This is used to complete informaton on DMEPOS suppliers' compliance with regulations found in 42 CFR section 424.57 as gathered during a visit to the physical location of the supplier upon initial enrollment or reenrollment into the Medicare program.
None
None
No
1
IC Title Form No. Form Name
On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR Section 424.57 HCFA-R-263
  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 40,000 40,000 0 0 0 0
Annual Time Burden (Hours) 20,000 20,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/02/1999