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

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.

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

Federal Enterprise Architecture: Health - Health Care Services

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