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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 201209-0938-002 · OMB 0938-0749 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-R-263 On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR, Section 424.57 Form and Instruction Modified Available
SV - supporting statement - 09202012.docx Supporting Statement A Uploaded 2012-09-20 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
8454 On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR, Section 424.57 Form and Instruction Modified
ICR Details
0938-0749 201209-0938-002
Historical Active 200809-0938-002
HHS/CMS
On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR, Section 424.57
Reinstatement without change of a previously approved collection   No
Regular
Approved with change 09/25/2012
Retrieve Notice of Action (NOA) 09/05/2012
  Inventory as of this Action Requested Previously Approved
09/30/2015 36 Months From Approved
30,000 0 0
15,000 0 0
0 0 0
CMS is mandated to identify and implement measures to prevent fraud and abuse in the Medicare program. To meet this challenge, CMS has moved forward to improve the quality of the process for enrolling suppliers into the Medicare program by establishing a uniform application for enumerating suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Implementation of enhanced procedures for verifying the enrollment information has also improved the enrollment process. As part of this process, verification of compliance with supplier standards is necessary. The site investigation form has been used in the past to aid the Medicare contractor (the National Supplier Clearinghouse and/or its subcontractors) in verifying compliance with the required supplier standards found in 42 CFR 424.57(c). The primary function of the site investigation form is to provide a standardized, uniform tool to gather information from a DMEPOS supplier that tells us whether it meets certain qualifications to be a DMEPOS supplier (as found in 42 CFR 424.57(c)) and where it practices or renders its services.
PL: Pub.L. 99 - 272 9202(g) Name of Law: Budget Reconciliation Act of 1985
   US Code: 5 USC 522(b)(4) Name of Law: The Freedom of Information Act
   EO: EO 12600 Name/Subject of EO: Predisclosure notification procedures for confidential commercial information
   US Code: 42 USC 1395l Name of Law: Payment of Benefits
   US Code: 42 USC 1395f Name of Law: Conditions of and limitations on payment for services
  
None
Not associated with rulemaking
  76 FR 60845 09/30/2011
77 FR 25182 04/27/2012
No
  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 30,000 0 0 0 0 30,000
Annual Time Burden (Hours) 15,000 0 0 0 0 15,000
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
No
No
No
Uncollected
William Parham 4107864669
  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.
09/05/2012