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Federal forms, ICRs, and supporting documents

OMB control number

[Medicaid] Limitations on Provider Related Donations and Health Care Related Taxes; Medicaid and Supporting Regulations in 42 CFR 433.68 and 433.74 (CMS-R-148)

OMB 0938-0618 · HHS/CMS.

OMB 0938-0618

This information collection is necessary to ensure compliance with Sections 1903 and 1923 of the Social Security Act for the purpose of preventing payment of FFP on amounts prohibited by statute.

The latest form for [Medicaid] Limitations on Provider Related Donations and Health Care Related Taxes; Medicaid and Supporting Regulations in 42 CFR 433.68 and 433.74 (CMS-R-148) expires 2027-09-30 and can be found here.

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