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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 7932 under ICR 202101-0938-005 · OMB 0938-0273.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 485.701-485.729

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-381 REQUEST FOR IDENTIFICATION OF OPT/OSP PROVIDER’S CMS form 381. 09.09.20.pdf No   Fillable Printable

Health Health Care Services

 

443 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 443 0 0 -1,718 0 2,161
Annual IC Time Burden (Hours) 111 0 0 -429 0 540
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Change Crosswalk for CMS-381. 09.04.20.docx 01/14/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.