OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

The Application for Federal Qualification (CMS 901A) Regulations in 42 CFR Section 417.140 and the Medicare Health Care Prepayment Plan Application (CMS 901D) in 42 CFR 417.800.

OMB 0938-0470 · HHS/CMS.

OMB 0938-0470
Latest Forms, Documents, and Supporting Material
Document
Name
Supporting Statement A
All Historical Document Collections
Approved without change
 Extension without change of a currently approved collection 2010-08-06
Approved without change
 Revision of a currently approved collection 2007-04-15
Approved with change
 Revision of a currently approved collection 2003-11-26
Approved without change
 Revision of a currently approved collection 2000-09-01
Approved without change
 Reinstatement without change of a previously approved collection 1997-09-03
Approved without change
 Reinstatement with change of a previously approved collection 1994-07-14
Approved without change
 Reinstatement with change of a previously approved collection 1993-10-18
Approved without change
 Reinstatement with change of a previously approved collection 1991-04-17
Approved without change
 Reinstatement with change of a previously approved collection 1988-08-05
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
 Revision of a currently approved collection 1986-04-22