Information Collection

Psychiatric Unit Criteria Work Sheet, Rehabilitation Hospital Criteria Work Sheet, And Rehabilitation Unit Critiera Work Sheet

IC 113531 under ICR 199105-0938-002 · OMB 0938-0358.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0358 can be found here:

Documents and Forms

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Information Collection (IC) Details

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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.	Available Electronically?	Can Be Submitted Electronically?
Form	437-A	No	No
Form	HCFA-437	No	No
Form	437-B	No	No

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,921	1,921
Annual IC Time Burden (Hours)	480	480
Annual IC Cost Burden (Dollars)	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.