Information Collection Request
End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration (CMS-2728)
ICR 202402-0938-004 · OMB 0938-0046 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0046 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-2728 End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration and Supporting Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts.... |
Form | Modified | Available |
| Form CMS-2728 End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration and Supporting Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts.... |
Form | Modified | Missing upstream |
 Non Substantive Change Memo (CMS-2728).docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-02-09 | Available |
| Non Substantive Change Memo (CMS-2728).docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-02-09 | Repair queued |
| CMS2728SupportStmt508 comment revisions 5-22-23.docx |
Supporting Statement A | Uploaded 2023-05-30 | Available |
| CMS2728SupportStmt508 comment revisions 5-22-23.docx |
Supporting Statement A | Uploaded 2023-05-30 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 7806 |  End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration and Supporting Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts.... |
Form | Modified | |
| 7806 | End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration and Supporting Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts.... |
Form | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0046 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202311-0938-015 |
| Agency Tracking No | CCSQ |
| Date Submitted to OIRA | 2024-02-09 |
| Requested Expiration Date | 1969-12-31 |