Information Collection

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

IC 7932 under ICR 201106-0938-019 · OMB 0938-0273.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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 Providers of Outpatient Therapy or Outpatient Speech Pathology (OPT/OSP) Services	IC Document

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Providers of Outpatient Therapy or Outpatient Speech Pathology (OPT/OSP) Services	PRA OPT 2290.pdf	06/16/2011

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