Information Collection

Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...

IC 7917 under ICR 201603-0938-013 · OMB 0938-0267.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0267 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-360 Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64... Form and Instruction
CMS-359 Comprehensive Outpatient Rehab Facility Request Form CMS-359 (with expire XX).pdf Form and Instruction
CMS-360 COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY SURVEY CMS-360 (with expire XX).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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-360	COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY SURVEY REPORT	CMS-360 (with expire XX).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-359	Comprehensive Outpatient Rehab Facility Request Form	CMS-359 (with expire XX).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	8	42
Annual IC Time Burden (Hours)	123	-14	137
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.