OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Independent Rural Health Clinic Cost Report (CMS-222-17)

OMB 0938-0107 · HHS/CMS.

OMB 0938-0107

The Form CMS-222-17 cost report is needed to determine program reimbursement and the amount of reasonable cost due to providers for furnishing medical services to Medicare beneficiaries.

The latest form for Independent Rural Health Clinic Cost Report (CMS-222-17) expires 2027-11-30 and is listed under ICR 202410-0938-004.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 222-17 Rural Health Clinic Cost ReportForm
CMS 222-17 Supporting Statement.docxSupporting Statement A
CMS 222-17 Supporting Statement.docxSupporting Statement A
Rural Health Clinic Cost Report (CMS-222-17) Form
Rural Health Clinic Cost Report (CMS-222-17) Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202410-0938-004 Extension without change of a currently approved collection 2024-10-17
202112-0938-011 Reinstatement without change of a previously approved collection 2022-01-06 Approved without change
201709-0938-008 Revision of a currently approved collection 2017-09-29 Approved with change
201408-0938-001 Extension without change of a currently approved collection 2014-08-28 Approved without change
201106-0938-003 Extension without change of a currently approved collection 2011-06-07 Approved with change
200803-0938-007 Extension without change of a currently approved collection 2008-03-28 Approved without change
200504-0938-010 Extension without change of a currently approved collection 2005-04-29 Approved without change
200208-0938-018 Extension without change of a currently approved collection 2002-08-29 Approved without change
199909-0938-007 Extension without change of a currently approved collection 1999-09-16 Approved without change
199607-0938-003 Revision of a currently approved collection 1996-07-08 Approved without change
199307-0938-001 Revision of a currently approved collection 1993-07-28 Approved without change
199211-0938-009 Reinstatement with change of a previously approved collection 1992-11-30 Approved without change
198905-0938-010 No material or nonsubstantive change to a currently approved collection 1989-05-05 Approved with change
198811-0938-009 Revision of a currently approved collection 1988-11-22 Approved without change
198602-0938-003 Reinstatement with change of a previously approved collection 1986-02-10 Approved without change
198308-0938-006 Reinstatement with change of a previously approved collection 1983-08-25 Approved without change
198212-0938-014 Reinstatement with change of a previously approved collection 1982-12-15 Approved without change
198008-0938-001 New collection (Request for a new OMB Control Number) 1980-08-25 Approved without change