Information Collection Request

Testing Experience and Functional Tools: Functional Assessment Standardized Items (FASI) Based on the CARE Tool (CMS-10243)

ICR 201608-0938-010 · OMB 0938-1037 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10243 Functional Assessment Standardized Items (FASI): Round 2 Form and Instruction New Available
Form CMS-10243 DATA COLLECTION FOR ADMINISTERING THE MEDICARECONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (Acute) Form and Instruction Removed Available
Form CMS-10243 DATA COLLECTION FOR ADMINISTERING THE MEDICARECONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (HHA) Form and Instruction Removed Available
Form CMS-10243 DATA COLLECTION FOR ADMINISTERING THE MEDICARE CONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (IRF) Form and Instruction Removed Available
Form CMS-10243 DATA COLLECTION FOR ADMINISTERING THE MEDICARECONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (LTCH) Form and Instruction Removed Repair queued
Form CMS-10243 DATA COLLECTION FOR ADMINISTERING THE MEDICARECONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (SNF) Form and Instruction Removed Available
Form CMS-10243 DATA COLLECTION FOR ADMINISTERING THE MEDICARE CONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (volunteers) Form and Instruction Removed Available
Response to AHCA Questions 081806.docx Supplementary Document Uploaded 2016-12-22 Available
CMS-10243 - Supporting Statement A [rev 08-12-2016 by OSORA PRA]508.docx Supporting Statement A Uploaded 2016-08-12 Available
Revised response to AHCA.docx Supplementary Document Uploaded 2016-08-12 Available
CSupportingStmtPartB508.docx Supporting Statement B Uploaded 2016-08-12 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2019 36 Months From Approved 03/31/2011
5,650 0 244,234
2,825 0 179,341
0 0 0





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 5,650 244,234 0 -238,584 0 0
Annual Time Burden (Hours) 2,825 179,341 0 -176,516 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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