Information Collection Request
Emergency and Foreign Hospital Services and Supporting Regulation in 42 CFR Section 424.103 (CMS-1771)
ICR 202211-0938-001 · OMB 0938-0023 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0023 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-1771 Emergency and Foreign Hospital Services |
Form | Modified | Repair queued |
 CMS-1771 Supporting Statement A.docx |
Supporting Statement A | Uploaded 2022-11-04 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 7770 |  Emergency and Foreign Hospital Services |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0023 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202002-0938-007 |
| Agency Tracking No | CM-FFS |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |