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Psychiatric Unit Criteria Work Sheet, Rehabilitation Hospital Criteria Work Sheet, And Rehabilitation Unit Critiera Work Sheet
PSYCHIATRIC UNIT CRITERIA WORK SHEET, REHABILITATION HOSPITAL CRITERIA WORK SHEET, AND REHABILITATION UNIT CRITIERA WORK SHEET
OMB: 0938-0358
IC ID: 113531
OMB.report
HHS/CMS
OMB 0938-0358
ICR 199105-0938-002
IC 113531
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0358 can be found here:
2021-06-01 - Revision of a currently approved collection
2017-12-05 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PSYCHIATRIC UNIT CRITERIA WORK SHEET, REHABILITATION HOSPITAL CRITERIA WORK SHEET, AND REHABILITATION UNIT CRITIERA WORK SHEET
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
437-A
No
No
Form
HCFA-437
No
No
Form
437-B
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,921
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,921
0
0
1,921
0
0
Annual IC Time Burden (Hours)
480
0
0
480
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.