Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)

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Documents and Forms

Document Name Document Type
Form CMS-437A Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B) Form and Instruction
CMS-437A Rehabilitiation Unit Criteria Worksheet CMS437A.pdf Form and Instruction
CMS-437B Rehabilitation Hospital Criteria Worksheet CMS437B.pdf Form and Instruction
Crosswalk for Changes to Rehabilitation Hospital Worksheet and Rehabilitation Unit Worksheet 6-24-12.docx Crosswalk for Changes to Rehabilitation Hospital Worksheet and Rehabilitation Unit Worksheet 6-24-12 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-437A	Rehabilitiation Unit Criteria Worksheet	CMS437A.pdf		Yes	No	Printable Only
Form and Instruction	CMS-437B	Rehabilitation Hospital Criteria Worksheet	CMS437B.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,164	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,164	-63	1,227
Annual IC Time Burden (Hours)	291	-16	307
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk for Changes to Rehabilitation Hospital Worksheet and Rehabilitation Unit Worksheet 6-24-12	Crosswalk for Changes to Rehabilitation Hospital Worksheet and Rehabilitation Unit Worksheet 6-24-12.docx	06/30/2012

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