End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration (CMS-2728)

OMB 0938-0046

OMB 0938-0046

The primary purpose of the END STAGE RENAL DISEASE MEDICAL EVIDENCE REPORT MEDICARE ENTITLEMENT AND/OR PATIENT REGISTRATION is to determine if an individual is entitled to Medicare under the End Stage Renal Disease provisions of the law. This form SHOULD NOT be completed for those patients who are in acute renal failure. Completion of the form is voluntary, but failure to do so may result in denial of Medicare benefits.

The latest form for End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration (CMS-2728) expires 2022-11-30 and can be found here.

All Historical Document Collections
Approved without change
No material or nonsubstantive change to a currently approved collection 2024-02-09
Approved without change
No material or nonsubstantive change to a currently approved collection 2023-11-28
Approved without change
Reinstatement with change of a previously approved collection 2023-05-30
Approved without change
Reinstatement with change of a previously approved collection 2019-06-04
Approved without change
No material or nonsubstantive change to a currently approved collection 2014-04-23
Approved without change
Revision of a currently approved collection 2013-10-25
Approved without change
Extension without change of a currently approved collection 2010-09-28
Approved without change
Extension without change of a currently approved collection 2007-06-29
Approved with change
Revision of a currently approved collection 2004-03-17
Approved without change
Extension without change of a currently approved collection 2001-06-05
Approved without change
Extension without change of a currently approved collection 1998-04-08
Approved without change
Revision of a currently approved collection 1997-04-30
Approved without change
Reinstatement with change of a previously approved collection 1996-07-02
Approved without change
Revision of a currently approved collection 1994-10-11
Approved without change
Revision of a currently approved collection 1993-09-08
Approved without change
Revision of a currently approved collection 1990-10-12
Approved without change
Revision of a currently approved collection 1987-10-29
Approved without change
Revision of a currently approved collection 1985-08-20
Approved without change
Reinstatement with change of a previously approved collection 1983-10-19
Approved without change
Revision of a currently approved collection 1981-02-25
Approved without change
Revision of a currently approved collection 1978-01-05

© 2024 OMB.report | Privacy Policy