Dynamic List Information
Dynamic List Data
Form #
CMS 1856
Form Title
Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services
Revision Date
2006-12-11
O.M.B. #
0938-0065
O.M.B. Expiration Date
0021-12-31
Special Instructions
N/A