OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medicare Provider Cost Report Reimbursement Questionnaire and Supporting Regulations in 42 CFR 413.20, 413.24, and 415.60 (CMS-339)

OMB 0938-0301 · HHS/CMS.

OMB 0938-0301

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-339 Medicare Provider Cost Reimbursement Questionnaire - Exhibit 1Form and Instruction
Form CMS-339 Medicare Provider Cost Reimbursement Questionnaire - Exhibit 2Form and Instruction
CMS-339 Supporting Statement Part A - FINAL 4-18-17.docSupporting Statement A
Medicare Provider Cost Report Reimbursement Questionnaire (Exhibit 1) Form and Instruction
Medicare Provider Cost Report Reimbursement Questionnaire (Exhibit 2) Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201704-0938-004 Reinstatement with change of a previously approved collection 2017-04-20 Approved without change
201611-0938-006 Reinstatement without change of a previously approved collection 2016-11-23 Improperly submitted
201305-0938-011 Reinstatement without change of a previously approved collection 2013-05-20 Approved without change
200903-0938-003 Reinstatement without change of a previously approved collection 2009-03-10 Approved without change
200604-0938-011 No material or nonsubstantive change to a currently approved collection 2006-04-25 Approved without change
200509-0938-009 Revision of a currently approved collection 2005-09-16 Approved with change
200208-0938-017 Revision of a currently approved collection 2002-08-29 Approved without change
200203-0938-006 Reinstatement without change of a previously approved collection 2002-03-29 Approved without change
200107-0938-003 Extension without change of a currently approved collection 2001-07-05 Approved without change
199805-0938-001 Extension without change of a currently approved collection 1998-05-07 Approved without change
199702-0938-008 No material or nonsubstantive change to a currently approved collection 1997-02-22 Approved with change
199505-0938-004 Revision of a currently approved collection 1995-05-15 Approved without change
199406-0938-001 Extension without change of a currently approved collection 1994-06-30 Approved without change
199403-0938-006 No material or nonsubstantive change to a currently approved collection 1994-03-11 Approved with change
199306-0938-009 Revision of a currently approved collection 1993-06-11 Approved without change
199006-0938-003 Revision of a currently approved collection 1990-06-25 Approved without change
198811-0938-006 Revision of a currently approved collection 1988-11-22 Approved without change
198510-0938-007 Revision of a currently approved collection 1985-10-11 Approved without change
198308-0938-014 New collection (Request for a new OMB Control Number) 1983-08-18 Approved without change