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

OMB 0938-0074

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 can be found here.

All Historical Document Collections
Extension without change of a currently approved collection 2021-06-01
Approved with change
Extension without change of a currently approved collection 2018-08-17
Improperly submitted and continue
Revision of a currently approved collection 2018-04-12
Approved without change
Extension without change of a currently approved collection 2015-04-08
Approved without change
Revision of a currently approved collection 2012-02-14
Approved without change
Revision of a currently approved collection 2008-12-17
Approved without change
Extension without change of a currently approved collection 2005-10-26
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Extension without change of a currently approved collection 2002-10-30
Approved without change
Extension without change of a currently approved collection 1999-09-15
Approved without change
Extension without change of a currently approved collection 1996-09-26
Approved without change
Reinstatement with change of a previously approved collection 1993-10-04
Approved without change
Reinstatement with change of a previously approved collection 1990-08-06
Approved without change
Revision of a currently approved collection 1989-03-13
Approved without change
Revision of a currently approved collection 1986-05-14
Approved without change
Reinstatement with change of a previously approved collection 1984-06-25
Approved with change
No material or nonsubstantive change to a currently approved collection 1982-03-30
Approved without change
New collection (Request for a new OMB Control Number) 1978-03-20
OMB Details

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

Federal Enterprise Architecture: Health - Health Care Services

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.


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