OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Certificate of Medical Necessity

OMB 1215-0113 ยท DOL/ESA.

OMB 1215-0113

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CM-893 Certificate of Medical NecessityForm and Instruction
Supporting Statement 1215-0113 09-2008.docSupporting Statement A
DOL Privacy Act systems ESA-30.pdf Supplementary Document
DOL Privacy Act systems ESA-6.pdf Supplementary Document
Pages from 2000 Regs for 1215-0113.pdf Supplementary Document
Certificate of Medical Necessity Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
200809-1215-001 Extension without change of a currently approved collection 2008-09-24 Approved without change
200509-1215-003 Extension without change of a currently approved collection 2005-09-13 Approved without change
200209-1215-004 Extension without change of a currently approved collection 2002-09-24 Approved without change
200003-1215-003 No material or nonsubstantive change to a currently approved collection 2000-03-20 Approved without change
200003-1215-002 No material or nonsubstantive change to a currently approved collection 2000-03-31 Approved without change
199908-1215-005 Extension without change of a currently approved collection 1999-08-27 Approved without change
199609-1215-001 Extension without change of a currently approved collection 1996-09-05 Approved without change
199307-1215-001 Revision of a currently approved collection 1993-07-22 Approved without change
199007-1215-001 Revision of a currently approved collection 1990-07-19 Approved without change
198906-1215-011 No material or nonsubstantive change to a currently approved collection 1989-06-26 Approved with change
198906-1215-006 No material or nonsubstantive change to a currently approved collection 1989-06-05 Approved with change
198707-1215-003 Revision of a currently approved collection 1987-07-31 Approved without change
198407-1215-010 Revision of a currently approved collection 1984-07-23 Approved without change
198309-1215-037 No material or nonsubstantive change to a currently approved collection 1983-09-06 Approved with change
198108-1215-001 New collection (Request for a new OMB Control Number) 1981-08-10 Approved without change