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

On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR, Section 424.57 (CMS-R-263)

Documents and Forms

Document Name Document Type
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
CMS-R-263 DMEPOS Site Visit Form CMS-R-263-072524.pdf Form and Instruction
CMS-R-263 - Appendix A - Site Investigation (DMEPOS).docx Supplier Standards Medicare DMEPOS suppliers IC Document

Information Collection (IC) Details

IC Title:	On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR, Section 424.57	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 424.57

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-263	DMEPOS Site Visit Form	CMS-R-263-072524.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,029	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	16,029	7,774	8,255
Annual IC Time Burden (Hours)	16,029	7,774	8,255
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supplier Standards Medicare DMEPOS suppliers	CMS-R-263 - Appendix A - Site Investigation (DMEPOS).docx	11/13/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.