Information Collection Request

Inpatient Rehabilitation Facilities Quality Reporting Program: Program Evaluation

ICR 201403-0938-008 · OMB 0938-1241 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10503 IRF Quality Reporting Program: Program Evaluation Form and Instruction New Available
CMS-10503 Supporting Statement B IRF Programs.docx Supporting Statement B Uploaded 2014-06-17 Available
IRF QRP Program Monitoring PRA package. Response to Public Comment. 02 28 14.docx Supplementary Document Uploaded 2014-03-18 Available
Burden Calculation. IRF Monitoring. 09.11.13.docx Supplementary Document Uploaded 2014-03-18 Available
CMS-10503 Supporting Statement A IRF Programs.docx Supporting Statement A Uploaded 2014-06-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
210818 IRF Quality Reporting Program: Program Evaluation Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2015 12 Months From Approved
30 0 0
71 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
IRF Quality Reporting Program: Program Evaluation CMS-10503 Structured Interview Questions for the IRF Setting

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 30 0 0 30 0 0
Annual Time Burden (Hours) 71 0 0 71 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No