Information Collection

Psychiatric Unit Criteria Worksheet, Rehabilitation Hospital Criteria Worksheet, And Rehabilitation Unit Criteria Worksheet

IC 113532 under ICR 199304-0938-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 WORKSHEET, REHABILITATION HOSPITAL CRITERIA WORKSHEET, AND REHABILITATION UNIT CRITERIA WORKSHEET	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	HCFA-437	No	No
Form	437-A	No	No
Form	437-B	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,202	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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,202	281	1,921
Annual IC Time Burden (Hours)	551	71	480
Annual IC Cost Burden (Dollars)	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.