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Federal forms, ICRs, and supporting documents

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

IC 187984 under ICR 201306-0938-003 · OMB 0938-0842.

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Instruction
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Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P
 
No Removed
 
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 IRF PAI Instrument CMS-10036.Draft IRF-PAI Instrument.pdf Yes No Fillable Fileable
Instruction CMS-10036.IRF-PAI pressure ulcer instructions for PRA.docx Yes No Fillable Fileable

Health Health Care Services

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

9 0
   
Federal Government
 
   100 %

  Requested 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 0 0 -3,330 0 0 3,330
Annual IC Time Burden (Hours) 0 0 -2,831 0 0 2,831
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10036_IRF-PAI_Revisions Crosswalk CMS-10036_IRF-PAI_Revisions Crosswalk.docx 06/01/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.