Information Collection

Data Collection For Administering The Medicare Continuity Assessment Record And Evaluation (care) Instrument (irf)

IC 183095 under ICR 201608-0938-010 · OMB 0938-1037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10243 DATA COLLECTION FOR ADMINISTERING THE MEDICARE CONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (IRF)	Form and Instruction
CMS-10243 CARE Tool CMS-10243.Appendix B MASTER CARE Tool 30 Day Revisions 103107.doc	Form and Instruction
CAREPrototypeScreens20070716.ppt CAREPrototypeScreens20070716	IC Document

IC Title:

DATA COLLECTION FOR ADMINISTERING THE MEDICARE CONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (IRF)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	CMS-10243	CARE Tool	CMS-10243.Appendix B MASTER CARE Tool 30 Day Revisions 103107.doc		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-16,296	16,296
Annual IC Time Burden (Hours)	-12,214	12,214
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CAREPrototypeScreens20070716	CAREPrototypeScreens20070716.ppt	11/15/2007

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