OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 (CMS-2744)

OMB 0938-0447 · HHS/CMS.

OMB 0938-0447

The ESRD Facility Survey form (CMS-2744) is completed annually by Medicare-approved providers of dialysis and transplant services. The CMS-2744 is designed to collect information concerning treatment trends utilization of services and patterns of practice in treating ESRD patients.

The latest form for End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 (CMS-2744) expires 2028-09-30 and can be found here.

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Approved without change
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Approved without change
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Approved without change
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Approved without change
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Approved with change
 No material or nonsubstantive change to a currently approved collection 1987-08-12
Approved with change
 No material or nonsubstantive change to a currently approved collection 1986-08-01
Approved without change
 New collection (Request for a new OMB Control Number) 1985-08-09