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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS-R-5 - Supporting Statement Part A- CLEAN(3.24.26).docx Supporting Statement A
Physician Certifications (14-43 days)
Physician Certifications (74-100 days)
Physician Certifications (44-73 days)
Physician Initial Certification (Less than 14 days)

All Historical Document Collections

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

OMB Details

Physician Certifications/Recertifications

Federal Enterprise Architecture: Health - Health Care Services