Comprehensive Outpatient Rehabilitation Facilites (CORFs) Conditions of Participation (CoP) and Supporting Regulations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10282 CORF Survey Report - Form 360	Form and Instruction	New	Available
Form CMS-10282 CORF Request for Certification Form - CMS-359	Form and Instruction	New	Available
CMS-10282 SuppStmt 7-12-13 PRA.pdf	Supporting Statement A	Uploaded 2013-11-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209506	CORF Survey Report - Form 360	Form and Instruction	New
209505	CORF Request for Certification Form - CMS-359	Form and Instruction	New
192450	42 CFR 485.66(b)(1), (2), and 3(i),(ii) Untilization review plan		Modified
192449	42 CFR 485.64(b)(2)		Removed
192448	42 CFR 485.64(b)(1)		Removed
192447	42 CFR 485.64(a)(1),(2),(3), (4), (b)(1) and (2) Disaster procedures		Modified
192446	42 CFR 485.58(c)		Removed
192445	42 CFR 485.56(e)		Removed
192444	42 CFR 485.56(d)		Removed
192443	42 CFR 485.56(c)		Removed
192442	42 CFR 485.56(b)		Removed
192441	42 CFR 485.54(a) and (b)		Removed

ICR Details

OMB Control No: 0938-1091	ICR Reference No: 201311-0938-030
Status: Historical Active	Previous ICR Reference No: 201004-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: 20940
Title: Comprehensive Outpatient Rehabilitation Facilites (CORFs) Conditions of Participation (CoP) and Supporting Regulations
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/12/2014
	Date Received in OIRA: 11/26/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved
Responses	628	0	0
Time Burden (Hours)	8,076	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection package is a request for reinstatement of information collection requirements. With this submission, we have updated the current number of CORFs and wages/salary figures. The current OMB collection 0938-0267 (2 forms) is being combined with this information collection package to move forward as one collection in the future. The information collection requirements, as discussed in the supporting statement are needed to implement the Medicare and Medicaid Conditions of Participation for 274 CORFs.

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Authorizing Statute(s): US Code: 42 USC 1395x(cc) Name of Law: Comprehensive Outpatient Rehabilitation Facility (CORFs) Services
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 45205	07/26/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 63983	10/25/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
42 CFR 485.64(a)(1),(2),(3), (4), (b)(1) and (2) Disaster procedures
42 CFR 485.66(b)(1), (2), and 3(i),(ii) Untilization review plan
CORF Request for Certification Form - CMS-359	CMS-10282	CORF Request for Certification to Participate in the Medicare Program
CORF Survey Report - Form 360	CMS-10282	CORF Survey Report
42 CFR 485.54(a) and (b)
42 CFR 485.56(b)
42 CFR 485.56(c)
42 CFR 485.56(d)
42 CFR 485.56(e)
42 CFR 485.58(c)
42 CFR 485.64(b)(1)
42 CFR 485.64(b)(2)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	628	0	0	-3,832	0	4,460
Annual Time Burden (Hours)	8,076	0	0	-22,029	0	30,105
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes to the burden are a reflection of the decrease in number of Medicare certified CORFs at this time compared to the previous collection and the changes in current average hourly rate for medical professionals used in the calculations.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/26/2013

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