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

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-381 Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381) Form and Instruction	Modified
CMS-381 Supporting Statement for CMS-381 (Clean 2-12-24).docx Supporting Statement A	2024-06-12

IC Document Collections

IC ID	Document Title	Status
7932	Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381) Form and Instruction	Modified