Information Collection Request
Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy (OPT) and/or Speech Pathology Services (OSP)- Initial and Extension Site Requests (CMS-381)
ICR 202406-0938-004 · OMB 0938-0273 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-381 Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381) |
Form and Instruction | Modified | Missing upstream |
 CMS-381 Supporting Statement for CMS-381 (Clean 2-12-24).docx |
Supporting Statement A | Uploaded 2024-06-12 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 7932 |  Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0273 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202101-0938-005 |
| Agency Tracking No | CCSQ |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |