Information Collection

Comprehensive Outpatient Rehabilitation Facility Eligibility & Survey Forms And Information Collection Requirements In 42 Cfr 488.56, 488.58, 488.60, 488.64, 488.66 And 405.262

IC 166221 under ICR 198509-0938-020 · OMB 0938-0267.

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Information Collection (IC) Details

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IC Title:

COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY ELIGIBILITY & SURVEY FORMS AND INFORMATION COLLECTION REQUIREMENTS IN 42 CFR 488.56, 488.58, 488.60, 488.64, 488.66 AND 405.262

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-359	No	No
Form	360	No	No
Form	HCFA-R-55	No	No

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	0	100
Annual IC Time Burden (Hours)	47,185	256	46,929
Annual IC Cost Burden (Dollars)	0	0	0

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