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

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

Document Name
r6P242 Supporting Statement A.docx Supporting Statement A
r6P242 Crosswalk.pdf Supplementary Document
Renal Dialysis Facility Cost Report Instruction

All Historical Document Collections

202205-0938-001 Approved with change	Reinstatement with change of a previously approved collection	2022-05-05
201709-0938-009 Approved with change	Extension without change of a currently approved collection	2017-09-29
201408-0938-013 Approved without change	Extension without change of a currently approved collection	2014-08-29
201110-0938-007 Approved without change	Revision of a currently approved collection	2011-10-14
201008-0938-022 Approved without change	Extension without change of a currently approved collection	2010-08-30
200705-0938-007 Approved without change	Extension without change of a currently approved collection	2007-05-29
200404-0938-005 Approved with change	Extension without change of a currently approved collection	2004-04-22
200105-0938-005 Approved without change	Extension without change of a currently approved collection	2001-05-21
199803-0938-006 Approved without change	Revision of a currently approved collection	1998-03-12
199501-0938-002 Approved without change	Revision of a currently approved collection	1995-01-19
199112-0938-003 Approved without change	Reinstatement with change of a previously approved collection	1991-12-05
198908-0938-005 Approved without change	Reinstatement with change of a previously approved collection	1989-08-30
198906-0938-013 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-06-16
198604-0938-007 Approved without change	Reinstatement with change of a previously approved collection	1986-04-16
198409-0938-022 Approved with change	No material or nonsubstantive change to a currently approved collection	1984-09-28
198405-0938-009 Approved without change	Reinstatement with change of a previously approved collection	1984-05-03
198112-0938-020 Approved without change	New collection (Request for a new OMB Control Number)	1981-12-04