OMB control number
Home Health Face-to-Face Encounter Clinical Templates (CMS-10564)
OMB 0938-1318 · HHS/CMS.
OMB 0938-1318
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10564 Physician Annual Burden for Completing the Electronic and Paper Clinical Template | Form and Instruction |
 CMS-10564 Supporting Statement Part A - FINAL 11-30-16.docx | Supporting Statement A |
| Revision to Form CMS 10564 Home Health .docx | Supplementary Document |
| Final Responses to HH Template PRA Comments.docx | Supplementary Document |
 Physician Annual Burden for Completing the Electronic and Paper Clinical Template |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201512-0938-012 | New collection (Request for a new OMB Control Number) | 2015-12-29 | Approved with change |