Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P

Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities

OMB: 0938-0842

IC ID: 187983

Information Collection (IC) Details

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Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 412 Subpart P

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument CMS-10036.pdf Yes Yes Paper Only
Instruction irfpai-manual040104.pdf Yes Yes Paper Only

Health Health Care Services

: Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) System of Records, System No. 09-70-1518  66 FR 56681

160 31
   
State, Local, and Tribal Governments
 
   100 %

  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 52,800 0 0 52,800 0 0
Annual IC Time Burden (Hours) 44,880 0 0 44,880 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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