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Federal forms, ICRs, and supporting documents

OMB control number

Physician Certifications/Recertification's in Skilled Nursing Facilities Manual Instruction (CMS-R-5)

OMB 0938-0454 · HHS/CMS.

OMB 0938-0454

Medicare, Skilled Nursing Facilities. 42 CFR 424.20 requires SNFs to keep record of physician certifications and recertification of information such as the need for care and services, estimated duration of the SNF stay, and plan for home care.

The latest form for Physician Certifications/Recertification's in Skilled Nursing Facilities Manual Instruction (CMS-R-5) expires 2023-04-30 and is listed under ICR 201912-0938-016.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
CMS-R-5 - Supporting Statement Part A- CLEAN(3.24.26).docxSupporting Statement A
Physician Certifications (14-43 days) Information collection
Physician Certifications (74-100 days) Information collection
Physician Certifications (44-73 days) Information collection
Physician Initial Certification (Less than 14 days) Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202606-0938-008 Reinstatement without change of a previously approved collection 2026-06-11
202212-0938-007 Extension without change of a currently approved collection 2022-12-21 Approved without change
201912-0938-016 Revision of a currently approved collection 2019-12-19 Approved with change
201612-0938-016 Reinstatement without change of a previously approved collection 2016-12-15 Approved without change
201610-0938-007 Reinstatement without change of a previously approved collection 2016-10-26 Improperly submitted
201306-0938-005 Reinstatement without change of a previously approved collection 2013-06-10 Approved without change
200907-0938-001 Extension without change of a currently approved collection 2009-07-21 Approved with change
200606-0938-008 Extension without change of a currently approved collection 2006-06-21 Approved without change
200302-0938-004 Extension without change of a currently approved collection 2003-02-21 Approved with change
200001-0938-002 Extension without change of a currently approved collection 2000-01-06 Approved without change
199805-0938-006 Reinstatement without change of a previously approved collection 1998-05-28 Approved without change
199412-0938-002 Reinstatement without change of a previously approved collection 1994-12-27 Approved without change
199102-0938-005 Reinstatement with change of a previously approved collection 1991-02-14 Approved without change
198509-0938-005 New collection (Request for a new OMB Control Number) 1985-09-13 Approved without change

OMB Details

Physician Certifications/Recertifications

Federal Enterprise Architecture: Health - Health Care Services