Information Collection

Comprehensive Outpatient Rehabilitation Facility (corf) Eligibility And Survey Forms And Information Collection Requirement In 42 Cfr 485.56, 485.58, 485.60, 485.66, And....

IC 113299 under ICR 199311-0938-002 · OMB 0938-0267.

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Information Collection (IC) Details

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IC Title:	COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF) ELIGIBILITY AND SURVEY FORMS AND INFORMATION COLLECTION REQUIREMENT IN 42 CFR 485.56, 485.58, 485.60, 485.66, AND....	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-359,	No	No
Form	HCFA-360,	No	No
Form	HCFA-R-55	No	No

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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	162	0	162
Annual IC Time Burden (Hours)	77,539	77,013	526
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.