Information Collection

End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133

IC 8062 under ICR 202505-0938-013 · OMB 0938-0447.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-2744A&B End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133	Form
Form CMS-2744A&B END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD FACILITY SURVEY End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133	Form
Form CMS-2744 B ESRD Medical Information System ESRD Facility Survey End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133	Form
CMS-2744.Current facility survey instructions.pdf	Instruction
CMS-2744.Current facility survey instructions.pdf	Instruction
CMS-2744A&B END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD CMS-2744A- ESRD Facility Survey.pdf	Form
CMS-2744A&B END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD CMS-2744A-rev091625.pdf	Form
CMS-2744 B ESRD Medical Information System ESRD Facility Survey CMS-2744B- ESRD Facility Survey.pdf	Form
CMS-2744 B ESRD Medical Information System ESRD Facility Survey CMS-2744B-rev091625.pdf	Form
2744-Crosswalk.pdf Crosswalk	IC Document
2744-Crosswalk.pdf Crosswalk	IC Document
CMS- 2744 Revised Crosswalk of Changes from 30 Day Public Comments.pdf Crosswalk for 30-day comments CMS-2744 A and B	IC Document
CMS-2744A- Redline ESRD Facility Survey (S to P Ratio Removal).pdf CMS-2744A redline	IC Document
CMS-2744B-Redline ESRD Facility Survey (Transplant Option changesv2).pdf CMS-2744B redline	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 422.Subpart E 45 CFR 5.5b 42 CFR 405.2133 20 CFR 401..

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-2744A&B	Yes	Yes	Fillable Fileable
Instruction		Yes	No	Printable Only
Form	CMS-2744 B	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: End Stage Renal Disease (ESRD) Program Management and Medical Information System (PMMIS)

FR Citation: 72 FR 26126

Number of Respondents: 7,726

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	7,726	-102	7,828
Annual IC Time Burden (Hours)	15,452	-15,860	31,312
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk		06/03/2025
Crosswalk for 30-day comments CMS-2744 A and B		09/29/2025
CMS-2744A redline		09/29/2025
CMS-2744B redline		09/29/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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