Reform of Requirements for Long-Term Care Facilities (CMS-10573)

OMB 0938-1363

Long term care facilities are required to maintain certain documentation within their own agency records that demonstrates compliance with specific requirements for participation in the Medicare and Medicaid programs. This documentation is maintained on-site for use in the long term care facility survey process.

The latest form for Reform of Requirements for Long-Term Care Facilities (CMS-10573) expires 2022-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS-10573 and 0938-1363 Supporting Statement 02-22-22 508 Compliant.docx Supporting Statement A
483.80(h)
483.80(g)
483.80(d)(3)(vi) & (vii)
483.80(d)(3)(iv)
483.80(d)(3)(ii) & (iii)
483.80(d)(3).
483.95(g)
483.95(f)
483.95(a) through 483.95(e)
483.90(i)(5)
483.85(e)
483.85(d)(1)
483.80(a)
483.70(e)
483.460(i)(3)
483.60(c)(4)
483.55
483.25(n)(2)
483.21(c)
483.21(b)(2)(ii)
483.21(a)
483.15(c)(4)
483.10(j)
485.10(g)(17)
483.10(f)(4)(v) through 483.10(f)(4)(vi)
483.10(c)(2)
483.85(c)
483.85(b)
483.75(b)(2)
483.75(a)

All Historical Document Collections

202206-0938-011 Approved with change	Revision of a currently approved collection	2022-06-09
201901-0938-005 Approved without change	Existing collection in use without an OMB Control Number	2019-06-14

OMB Details

483.75(a)

Federal Enterprise Architecture: Health - Health Care Services