OMB control number
End Stage Renal Disease Death Notification (CMS-2746)
OMB 0938-0448 · HHS/CMS.
OMB 0938-0448
The primary purpose of the ESRD Death Notification is to collect demographic characteristics and cause of death regarding an ESRD patient. It is to be completed within 2 weeks of the date of death of an ESRD patient. If the patient was a dialysis patient, the dialysis facility last responsible for the patient’s maintenance dialysis (or home dialysis) must complete this form. If the patient was a transplant patient, the transplant center is responsible for completing this form.
The latest form for End Stage Renal Disease Death Notification (CMS-2746) expires 2027-03-31 and is listed under ICR 202505-0938-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-2746 ESRD Death Notification Form | Form |
| Form CMS-2746 End Stage Renal Disease Death Notification, P.L. 95-292; 42 CFR 405.2133; 45 CFR 5,5b; 20 CFR Parts 401, 422E | Form |
 CMS-2746 Non Substantive Change Memo EO14168 -5-14-25.docx | Justification for No Material/Nonsubstantive Change |
| CMS-2746 Non Substantive Change Memo EO14168 -5-14-25.docx | Justification for No Material/Nonsubstantive Change |
| CMS-2746 Supporting Stmt. EO14168 clean v1.docx | Supporting Statement A |
| CMS-2746 Supporting Stmt. EO14168 clean v1.docx | Supporting Statement A |
 End Stage Renal Disease Death Notification, P.L. 95-292; 42 CFR 405.2133; 45 CFR 5,5b; 20 CFR Parts 401, 422E |
Form |
| End Stage Renal Disease Death Notification, P.L. 95-292; 42 CFR 405.2133; 45 CFR 5,5b; 20 CFR Parts 401, 422E |
Form |