OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

(CMS-29) Request for Certification as Rural Health Clinic Form and Supporting Regulations

OMB 0938-0074 · HHS/CMS.

OMB 0938-0074

The Form CMS-29 is utilized as an application to be completed by suppliers of RHC services requesting participation in the Medicare/Medicaid programs. This form initiates the process of obtaining a decision as to whether the conditions for certification are met as a supplier of RHC services. It also promotes data reduction or introduction to and retrieval from the Automated Survey Process Environment (ASPEN) and related survey and certification databases by the CMS Regional Offices.

The latest form for (CMS-29) Request for Certification as Rural Health Clinic Form and Supporting Regulations expires 2021-09-30 and is listed under ICR 201808-0938-008.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-29 Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare ProgramForm and Instruction
CMS-29 Supporting Statement A. 03.16.21.docxSupporting Statement A
Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program Form and Instruction
Medical Secretary to complete mailing for all RHCs surveyed Information collection
Preparation for and mailing of the CMS-29 Form to the State agencies Information collection
Medical Secretary to compulete survey task -RHCs being surveyed Information collection
Photocopying of CMS-29 and filing by a Medical Secretary Information collection
New RHCs review the statutory and regulatory law Information collection
Completion of the Survey CMS-29 Form for state survey agency triennial survey Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202106-0938-001 Extension without change of a currently approved collection 2021-06-01 Approved with change
201808-0938-008 Extension without change of a currently approved collection 2018-08-17 Approved with change
201803-0938-005 Revision of a currently approved collection 2018-04-12 Improperly submitted and continue
201504-0938-006 Extension without change of a currently approved collection 2015-04-08 Approved without change
201202-0938-005 Revision of a currently approved collection 2012-02-14 Approved without change
200812-0938-002 Revision of a currently approved collection 2008-12-17 Approved without change
200510-0938-009 Extension without change of a currently approved collection 2005-10-26 Approved without change
200210-0938-008 Extension without change of a currently approved collection 2002-10-30 Approved without change
199909-0938-006 Extension without change of a currently approved collection 1999-09-15 Approved without change
199609-0938-009 Extension without change of a currently approved collection 1996-09-26 Approved without change
199310-0938-004 Reinstatement with change of a previously approved collection 1993-10-04 Approved without change
199008-0938-001 Reinstatement with change of a previously approved collection 1990-08-06 Approved without change
198903-0938-006 Revision of a currently approved collection 1989-03-13 Approved without change
198605-0938-003 Revision of a currently approved collection 1986-05-14 Approved without change
198406-0938-006 Reinstatement with change of a previously approved collection 1984-06-25 Approved without change
198203-0938-015 No material or nonsubstantive change to a currently approved collection 1982-03-30 Approved with change
197803-0938-002 New collection (Request for a new OMB Control Number) 1978-03-20 Approved without change

OMB Details

Completion of the initial CMS-29 Form -new RHCs applying to participate in Medicare Program

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form CMS-29Verification of Clinic Data - Rural Health Clinic ProgramPrintable OnlyForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.