OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Physician Certifications/Recertification's in Skilled Nursing Facilities Manual Instruction (CMS-R-5)

ICR 202606-0938-008 · OMB 0938-0454 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
CMS-R-5 - Supporting Statement Part A- CLEAN(3.24.26).docx Supporting Statement A Uploaded 2026-06-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
43658 Physician Certifications (14-43 days) Modified
280882 Physician Certifications (74-100 days) New
280881 Physician Certifications (44-73 days) New
190006 Physician Initial Certification (Less than 14 days) Modified
ICR Details
0938-0454 202606-0938-008
Received in OIRA 202212-0938-007
HHS/CMS CM-FFS
Physician Certifications/Recertification's in Skilled Nursing Facilities Manual Instruction (CMS-R-5)
Reinstatement without change of a previously approved collection   No
Regular 06/11/2026
  Requested Previously Approved
36 Months From Approved
3,882,413 0
480,957 0
0 0
Medicare, Skilled Nursing Facilities. 42 CFR 424.20 requires SNFs to keep record of physician certifications and recertification of information such as the need for care and services, estimated duration of the SNF stay, and plan for home care.
PL: Pub.L. 101 - 239 1814(a)(2) Name of Law: Requirement of Requests and Certifications
  
None
Not associated with rulemaking
  91 FR 17280 04/06/2026
91 FR 35214 06/10/2026
No
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,882,413 0 0 1,567,154 0 2,315,259
Annual Time Burden (Hours) 480,957 0 0 -41,242 0 522,199
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
The change in burden is due to a 14% decrease in responses for SNF stays of up to 100 days.
$0
No
    No
    No
No
No
No
No
Malcolm Wilson 667 414-0087 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/11/2026