Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0273 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-381 Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381) Form and Instruction
CMS-381 Model Letter Requesting Identification of Extension Loca Form CMS-381.pdf Form and Instruction
PRA OPT 2290.pdf PRA OPT 2290 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 485.701-485.729

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-381	Model Letter Requesting Identification of Extension Locations	Form CMS-381.pdf		No	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,960	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,960	2,960
Annual IC Time Burden (Hours)	740	740
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PRA OPT 2290	PRA OPT 2290.pdf	08/26/2008

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