Independent Renal Dialysis Facility Cost Report (CMS-265-11)

OMB 0938-0236

OMB 0938-0236

The Renal Dialysis Facility Cost Report provides for the determination and allocation of costs to the components of the facility in order to establish a proper basis for Medicare payment.

The latest form for Independent Renal Dialysis Facility Cost Report (CMS-265-11) expires 2021-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material
All Historical Document Collections
Reinstatement with change of a previously approved collection 2022-05-05
Approved with change
Extension without change of a currently approved collection 2017-09-29
Approved without change
Extension without change of a currently approved collection 2014-08-29
Approved without change
Revision of a currently approved collection 2011-10-14
Approved without change
Extension without change of a currently approved collection 2010-08-30
Approved without change
Extension without change of a currently approved collection 2007-05-29
Approved with change
Extension without change of a currently approved collection 2004-04-22
Approved without change
Extension without change of a currently approved collection 2001-05-21
Approved without change
Revision of a currently approved collection 1998-03-12
Approved without change
Revision of a currently approved collection 1995-01-19
Approved without change
Reinstatement with change of a previously approved collection 1991-12-05
Approved without change
Reinstatement with change of a previously approved collection 1989-08-30
Approved with change
No material or nonsubstantive change to a currently approved collection 1989-06-16
Approved without change
Reinstatement with change of a previously approved collection 1986-04-16
Approved with change
No material or nonsubstantive change to a currently approved collection 1984-09-28
Approved without change
Reinstatement with change of a previously approved collection 1984-05-03
Approved without change
New collection (Request for a new OMB Control Number) 1981-12-04

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