OMB control number

(CMS-1856) Outpatient Physical Therapy Speech Pathology Survey Report and Supporting Regulations

OMB 0938-0065 · HHS/CMS.

OMB 0938-0065

The Medicare Program surveys providers of outpatient physical therapy and sppech-language patholgy services to determine compliance with Federal Regulations. The request for certification form is used by State Agency surveyors to determine if minimum Medicare eligibility requirements are met. The survey report form records the result of the on-site survey.

The latest form for (CMS-1856) Outpatient Physical Therapy Speech Pathology Survey Report and Supporting Regulations expires 2021-12-31 and is listed under ICR 201805-0938-014.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-1856 Outpatient Physical Therapy Speech Pathology Survey Report and Supporting Regulation in 42 CFR 485.701-485.729	Form and Instruction
CMS-1856 Response_to_Public_Comments 8-6-21.docx	Supplementary Document
CMS-1856 Supporting Statement (CLEAN 6-1-21).docx	Supporting Statement A
Outpatient Physical Therapy Speech Pathology Survey Report and Supporting Regulation in 42 CFR 485.701-485.729	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202108-0938-005	Extension without change of a currently approved collection	2021-08-13	Approved without change
201805-0938-014	Reinstatement with change of a previously approved collection	2018-05-22	Approved without change
201408-0938-005	Revision of a currently approved collection	2014-08-28	Approved without change
201106-0938-020	Extension without change of a currently approved collection	2011-06-21	Approved without change
200809-0938-007	Extension without change of a currently approved collection	2008-09-04	Approved without change
200509-0938-013	Extension without change of a currently approved collection	2005-09-19	Approved without change
200208-0938-014	Extension without change of a currently approved collection	2002-08-29	Approved without change
199907-0938-002	Reinstatement without change of a previously approved collection	1999-07-01	Approved without change
199603-0938-006	Reinstatement with change of a previously approved collection	1996-03-20	Approved without change
199205-0938-003	Revision of a currently approved collection	1992-05-28	Approved without change
199111-0938-001	Revision of a currently approved collection	1991-11-21	Approved without change
198907-0938-005	Reinstatement with change of a previously approved collection	1989-07-13	Approved without change
198904-0938-017	No material or nonsubstantive change to a currently approved collection	1989-04-03	Approved with change
198708-0938-013	No material or nonsubstantive change to a currently approved collection	1987-08-07	Approved with change
198605-0938-002	Revision of a currently approved collection	1986-05-06	Approved without change
198406-0938-005	Reinstatement with change of a previously approved collection	1984-06-25	Approved without change
198212-0938-013	Revision of a currently approved collection	1982-12-15	Disapproved and continue
198204-0938-010	Reinstatement with change of a previously approved collection	1982-04-02	Approved without change
198107-0938-017	No material or nonsubstantive change to a currently approved collection	1981-07-28	Approved with change
198102-0938-018	Reinstatement with change of a previously approved collection	1981-02-27	Approved without change
198006-0938-003	Reinstatement with change of a previously approved collection	1980-06-09	Approved without change
197803-0938-015	No material or nonsubstantive change to a currently approved collection	1978-03-29	Approved with change
197710-0938-006	Revision of a currently approved collection	1977-10-03	Approved without change
197709-0938-003	Revision of a currently approved collection	1977-09-13	Not subject to PRA and continue
197412-0938-004	Revision of a currently approved collection	1974-12-16	Approved without change