OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medicaid Disproportionate Share Hospital Annual Reporting (CMS-R-266)

OMB 0938-0746 · HHS/CMS.

OMB 0938-0746

Section 1923(a)(2)(D) of the Act requires the States to submit an annual report that identifies each DHS payment under the State's Medicaid program in the preceding fiscal year and the amount of DSH payments paid to that hospital in the same year and such other information as the Secretary determines necessary to ensure the appropriateness of DHS payments. The information supplied will satisfy the requirements under section 1923(a)(2)(D) of the Act as well.

The latest form for Medicaid Disproportionate Share Hospital Annual Reporting (CMS-R-266) expires 2027-04-30 and is listed under ICR 202404-0938-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-R-266 Medicaid Disproportionate Share Hospital (DSH) Annual ReportForm
CMS-R-266 - Supporting Statement A (CMS-2445-F version 3).docxSupporting Statement A
Medicaid Disproportionate Share Hospital (DSH) Annual Report Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202404-0938-003 Revision of a currently approved collection 2024-04-03 Approved without change
202309-0938-010 Extension without change of a currently approved collection 2023-09-19 Approved without change
202302-0938-014 Revision of a currently approved collection 2023-03-02 Comment filed on proposed rule and continue
202006-0938-002 Extension without change of a currently approved collection 2020-06-05 Approved without change
201703-0938-012 Extension without change of a currently approved collection 2017-03-23 Approved without change
201401-0938-019 Revision of a currently approved collection 2014-01-31 Approved without change
201306-0938-008 Revision of a currently approved collection 2013-06-18 Comment filed on proposed rule and continue
201104-0938-006 Extension without change of a currently approved collection 2011-04-27 Approved without change
200806-0938-005 Extension without change of a currently approved collection 2008-06-17 Approved without change
200507-0938-012 Revision of a currently approved collection 2005-07-28 Approved without change
200207-0938-015 Reinstatement without change of a previously approved collection 2002-07-30 Approved without change
200205-0938-003 Extension without change of a currently approved collection 2002-05-02 Withdrawn and continue
199904-0938-002 Extension without change of a currently approved collection 1999-04-15 Approved without change
199810-0938-003 New collection (Request for a new OMB Control Number) 1998-10-14 Approved without change