Information Collection Request
Worksheet for Recording Results of Medicare Site Visits of Independent Diagnostic Testing Facilities (IDTFs) (CMS-10221)
ICR 202306-0938-004 · OMB 0938-1029 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10221 Worksheet for Recording Results of Medicare Site Visits of Independent Diagnostic Testing Facilities (IDTFs) |
Form and Instruction | Modified | Repair queued |
 CMS-10221 - Supporting Statement --.docx |
Supporting Statement A | Uploaded 2023-06-06 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 181196 |  Worksheet for Recording Results of Medicare Site Visits of Independent Diagnostic Testing Facilities (IDTFs) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1029 |
| Type of Information Collection | Reinstatement without change of a previously approved collection |
| Previous ICR Reference No | 202001-0938-003 |
| Agency Tracking No | CMS-10221 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |