OMB control number
Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b) (CMS-10242)
OMB 0938-1049 · HHS/CMS.
OMB 0938-1049
Because it is very difficult to obtain a beneficiary's signature (or the signature of a person authorized to sign on behalf of the beneficiary) on a claim when the beneficiary is being transported by ambulance in emergency situations, we are proposing that, for emergency ambulance transport services, an ambulance provider or supplier may submit the claim without a beneficiary's signature, as long as certain documentation requirements are met.
The latest form for Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b) (CMS-10242) expires 2026-06-30 and can be found here.
Latest Forms, Documents, and Supporting Material
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Supplementary Document |
Supporting Statement A |
All Historical Document Collections
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Approved without change |
Extension without change of a currently approved collection | 2023-04-12 | |
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Extension without change of a currently approved collection | 2020-03-03 | |
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Approved without change |
Revision of a currently approved collection | 2016-12-15 | |
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Improperly submitted and continue |
Extension without change of a currently approved collection | 2016-10-26 | |
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Approved without change |
Reinstatement with change of a previously approved collection | 2013-09-10 | |
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Approved without change |
New collection (Request for a new OMB Control Number) | 2008-03-11 |