OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Home Office Cost Statement (CMS-287-22)

OMB 0938-0202 ยท HHS/CMS.

OMB 0938-0202

Home Office Cost Statement Form CMS-287-22 is filed annually by home office/chain organizations (HO/CO) to report the information necessary for the determination of Medicare reimbursement of components of the HO/CO. To the extent the HO/CO furnishes services related to patient care to a provider, the reasonable costs of such services are included in the provider's cost report and are reimbursable as part of the provider's costs.

The latest form for Home Office Cost Statement (CMS-287-22) expires 2027-10-31 and is listed under ICR 202408-0938-039.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-287-21 Home Office Cost Statement and Supporting Regulations in 42 CFR 413.17 and 413.20 (CMS-287-21)Form
Supporting Statement-CMS-287-22.docxSupporting Statement A
Crosswalk-287-22.pdf Supplementary Document
Home Office Cost Statement and Supporting Regulations in 42 CFR 413.17 and 413.20 (CMS-287-21) Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202408-0938-039 Extension without change of a currently approved collection 2024-08-29
202012-0938-018 Reinstatement with change of a previously approved collection 2020-12-24
201410-0938-012 Reinstatement without change of a previously approved collection 2014-10-17 Approved without change
201106-0938-005 Extension without change of a currently approved collection 2011-06-08 Approved without change
200804-0938-005 Extension without change of a currently approved collection 2008-04-29 Approved without change
200504-0938-011 Extension without change of a currently approved collection 2005-04-29 Approved without change
200204-0938-001 Extension without change of a currently approved collection 2002-04-05 Approved without change
199903-0938-001 Extension without change of a currently approved collection 1999-03-05 Approved without change
199605-0938-004 Extension without change of a currently approved collection 1996-05-08 Approved without change
199304-0938-001 Reinstatement with change of a previously approved collection 1993-04-05 Approved without change
199206-0938-007 Revision of a currently approved collection 1992-06-17 Approved without change
199107-0938-008 Reinstatement with change of a previously approved collection 1991-07-23 Approved without change
198910-0938-002 Reinstatement with change of a previously approved collection 1989-10-27 Approved without change
198708-0938-011 No material or nonsubstantive change to a currently approved collection 1987-08-07 Approved with change
198606-0938-005 Reinstatement with change of a previously approved collection 1986-06-16 Approved without change
198410-0938-016 No material or nonsubstantive change to a currently approved collection 1984-10-29 Approved with change
198303-0938-002 Revision of a currently approved collection 1983-03-11 Approved without change
198111-0938-005 New collection (Request for a new OMB Control Number) 1981-11-19 Approved without change