End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 (CMS-2744)

OMB 0938-0447

The ESRD Facility Survey form (CMS-2744) is completed annually by Medicare-approved providers of dialysis and transplant services. The CMS-2744 is designed to collect information concerning treatment trends utilization of services and patterns of practice in treating ESRD patients.

The latest form for End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 (CMS-2744) expires 2023-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-2744A&B End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 Form
CMS-2744 Supporting Statement Part B (12-29-16).doc Supporting Statement B
CMS- 2744 Supporting Statement - 11-27-19 (PRA comments) (003).docx Supporting Statement A
End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 Form

All Historical Document Collections

202005-0938-001 Approved without change	Reinstatement with change of a previously approved collection	2020-05-07
201612-0938-024 Approved without change	Extension without change of a currently approved collection	2016-12-29
201308-0938-023 Approved without change	Extension without change of a currently approved collection	2013-08-23
201007-0938-004 Approved without change	Reinstatement without change of a previously approved collection	2010-07-14
200609-0938-003 Approved without change	Extension without change of a currently approved collection	2006-09-21
200311-0938-006 Approved without change	Revision of a currently approved collection	2003-11-17
200302-0938-002 Approved without change	Extension without change of a currently approved collection	2003-02-21
200002-0938-006 Approved without change	Extension without change of a currently approved collection	2000-02-24
199704-0938-008 Approved without change	Extension without change of a currently approved collection	1997-04-30
199606-0938-005 Approved without change	Reinstatement with change of a previously approved collection	1996-06-20
199303-0938-008 Approved without change	Revision of a currently approved collection	1993-03-24
199008-0938-002 Approved without change	Extension without change of a currently approved collection	1990-08-15
199004-0938-006 Approved without change	Revision of a currently approved collection	1990-04-09
198806-0938-002 Approved without change	Revision of a currently approved collection	1988-06-06
198708-0938-017 Approved with change	No material or nonsubstantive change to a currently approved collection	1987-08-12
198608-0938-020 Approved with change	No material or nonsubstantive change to a currently approved collection	1986-08-01
198508-0938-004 Approved without change	New collection (Request for a new OMB Control Number)	1985-08-09