OMB control number

Omnibus COVID-19 Health Care Staff Vaccination (IFC) (CMS-10801)

OMB 0938-1414 · HHS/CMS.

OMB 0938-1414

Latest forms, documents, and information collections
Document	Type
CMS-10801 Supporting Statement 12-23-21.docx	Supporting Statement A
ESRD facilities documentation	Information collection
ESRD facilities Policies and procedures	Information collection
RHCs and FQHCs documentation	Information collection
RHCs and FQHCs policies and procedures	Information collection
HIT documentation	Information collection
HIT suppliers Policies and procedures	Information collection
CMHCs documentation	Information collection
CMHC Policies and procedures	Information collection
Organizations documentation	Information collection
Organizations policies and procedures	Information collection
CAHs Policies and procedures	Information collection
CORFs documentation	Information collection
CORF Policies and procedures	Information collection
HHA documentation	Information collection
HHA Policies and procedures	Information collection
ICFDs/IIDs documentation	Information collection
iCFs/IIDs Policies and procedures	Information collection
LTC Policies and Procedures	Information collection
Hospital Documentation	Information collection
Hospitals Policies and procedures	Information collection
PACE documentation	Information collection
PACE Policies and procedures	Information collection
PRTF documentation	Information collection
PRTFs Policies and procedures	Information collection
Hospice documentation	Information collection
Hospices - Policies and procedures	Information collection
ASC documentation	Information collection
ASC Policies and procedures	Information collection

Historical document collections
Reference	Filing	Received	Concluded	Action
202201-0938-004	New collection (Request for a new OMB Control Number)	2022-01-07		Approved with change