Information Collection

Outpatient Rehabilitation Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

IC 7791 under ICR 201401-0938-006 · OMB 0938-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2088.92 Manual Instructions.doc	Instruction
CMS-2088-92 Outpatient Rehabilitation Provider Cost Report Identific 2088.92 Forms-508.pdf	Form

IC Title:

Outpatient Rehabilitation Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 413.24 42 CFR 413.20 42 CFR 410.110

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2088.92 Manual Instructions.doc		Yes	No	Printable Only
Form	CMS-2088-92	Outpatient Rehabilitation Provider Cost Report Identification Data, Certification and Settlement Summary	2088.92 Forms-508.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 540

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	540	-56	596
Annual IC Time Burden (Hours)	54,000	-5,600	59,600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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