OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

(CMS-3427) End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations

OMB 0938-0360 · HHS/CMS.

OMB 0938-0360

This form is a facility identification and screening measurement used to initiate the certification and recertification of ESRD facilities.

The latest form for (CMS-3427) End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations expires 2022-03-31 and is listed under ICR 202002-0938-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-3427 End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations 42 CFR 488.60Form and Instruction
Supporting Statement-CMS-3427 2022 Clean 021022.docxSupporting Statement A
End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations 42 CFR 488.60 Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202205-0938-004 Reinstatement with change of a previously approved collection 2022-05-04 Approved without change
202002-0938-003 Reinstatement with change of a previously approved collection 2020-02-12 Approved without change
201603-0938-007 Reinstatement with change of a previously approved collection 2016-03-09 Approved with change
200311-0938-003 Extension without change of a currently approved collection 2003-11-12 Approved without change
200009-0938-013 Extension without change of a currently approved collection 2000-09-29 Approved without change
199703-0938-004 Reinstatement with change of a previously approved collection 1997-03-14 Approved without change
199411-0938-002 Reinstatement without change of a previously approved collection 1994-11-02 Disapproved
199009-0938-007 Revision of a currently approved collection 1990-09-25 Approved without change
198802-0938-004 Revision of a currently approved collection 1988-02-23 Approved without change
198605-0938-012 Revision of a currently approved collection 1986-05-16 Approved without change
198509-0938-015 No material or nonsubstantive change to a currently approved collection 1985-09-20 Approved with change
198406-0938-003 New collection (Request for a new OMB Control Number) 1984-06-25 Approved without change