OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Hospice Conditions of Participation (CMS-10277)

OMB 0938-1067 · HHS/CMS.

OMB 0938-1067

The CoPs and accompanying requirements specified in the regulations are used by Federal or State surveyors as a basis for determining whether a hospice qualifies for approval or re-approval under Medicare. CMS and the healthcare industry believe that the availability to the hospice of the type of records and general content of records, which this regulation specifies, is standard medical practice, and is necessary in order to ensure the well-being and safety of patients and professional treatment accountability.

The latest form for Hospice Conditions of Participation (CMS-10277) expires 2029-02-28 and is listed under ICR 202508-0938-020.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
CMS-10277 - Model Hospice Election Statement Addendum.docxSupplementary Document
CMS-10277 - SPA Model Hospice Election Statement Addendum.docxSupplementary Document
CMS-10277 - SPA Model Example of Hospice Election Statement.docxSupplementary Document
CMS-10277 - Model Example of Hospice Election Statement.docxSupplementary Document
CMS-2026-1156-0065-A1.pdfPublic Comments
CMS-2026-1156-0011-A1.pdfPublic Comments
CMS--10277 - Supporting Statement - Clean.docxSupporting Statement A
CMS-10277 - Response to Comments.docxSupplementary Document
Hospice Conditions of Participation 418.22(b) Certification Form Development Information collection
Hospice Conditions of Participation 418.58(a)(2) ID new measures Information collection
Hospice Conditions of Participation 418.114 (b)(3)(i)(B) Information collection
Hospice Conditions of Participation 418.110 (o)(4) Information collection
Hospice Conditions of Participation 418.76(b)(4) Newly certified Facilities Information collection
Hospice Conditions of Participation 418.76(b)(4) Existing Facilities Information collection
Hospice Conditions of Participation 418.56(c) Information collection
§418.24(c) Addendum Form Development Information collection
§418.24(c) Addendum Form Completion Information collection
Hospice Conditions of Participation 418.108(c)(3) Information collection
Hospice Conditions of Participation 418.58(a)(2) Organize QAPI Data Information collection
Hospice Conditions of Participation 418.58 (a)(2) Document Analysis Information collection
Hospice Condition of Participation 418.58(a)(2) Collect and record data Information collection
Hospice Conditions of Participation 418.58(a)(2) Develop QAPI program Information collection
Hospice Conditions of Participation 418.108(c)(1) Information collection
Hospice Conditions of Participation 418.52(b)(4) Information collection
Hospice Condtions of Participation 418.52(a)(1) Information collection
Hospice Conditions of Participation 418.28(d) develop revocation form Information collection
Hospice Conditions of Participation 418.24(b) explain election statement Information collection
Hospice Conditions of Participation 418.28(d) explain revocation form Information collection
Hospice Conditons of Participation 418.24 develop election form Information collection
Hospice Conditions of Participation 418.22(b)(5) Information collection
Hospice Condition of Participation (418.22(b)(4) Information collection
Hospice Conditions of Participation 418.22(b)(3) Information collection
Hospice Conditions of Participation 418.114 (d) Newly Certified Facility Information collection
Hospice Conditions of Participation 418.114 (d) Information collection
Hospice Conditions of Participation 418.112(e)(3) Information collection
Hospice Conditions of Participation (418.110 (o)(2) newly certified facilities Information collection
Hospice Conditions of Participation 418.110(n)(11) and (n)(15) Information collection
Hospice Conditions of Participation 418.106 (e)(2)(i)(C) Information collection
Hospice Conditions of Participation 418.78(a)(c)(d) and (e) Information collection
Hospice Conditions of Participation 418.76(d)(2) Information collection
Hospice Conditions of Participation 418.56(b) Information collection
Hospice Conditions of Participation (418.52(a)(3) Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202609-0938-008 Revision of a currently approved collection 2026-09-11
202604-0938-016 Revision of a currently approved collection 2026-06-01
202508-0938-020 Reinstatement with change of a previously approved collection 2025-08-28
202104-0938-008 Extension without change of a currently approved collection 2021-04-16 Comment filed on proposed rule and continue
202103-0938-005 Revision of a currently approved collection 2021-03-01 Approved without change
202005-0938-006 Revision of a currently approved collection 2020-05-13 Comment filed on proposed rule and continue
201911-0938-003 Revision of a currently approved collection 2019-11-20 Approved without change
201809-0938-005 Revision of a currently approved collection 2018-09-25 Comment filed on proposed rule and continue
201803-0938-001 Reinstatement without change of a previously approved collection 2018-03-16 Approved with change
201406-0938-002 Reinstatement with change of a previously approved collection 2014-06-23 Approved without change
201011-0938-017 Revision of a currently approved collection 2010-11-30 Approved without change
201008-0938-012 Revision of a currently approved collection 2010-08-19 Comment filed on proposed rule and continue
200906-0938-010 New collection (Request for a new OMB Control Number) 2009-06-15 Approved without change

OMB Details

Hospice Conditions of Participation (418.52(a)(3)

Federal Enterprise Architecture: Health - Health Care Services