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 202009-0938-003 · OMB 0938-0267.

⚠️ Notice: This information collection may be referencing outdated material.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

2025-06-04 - Reinstatement with change of a previously approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-359 Comprehensive Outpatient Rehab Facility Request Form 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
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
Form CMS-360 COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY SURVEY REPORT 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.Revised.05.29.20.pdf	Form and Instruction
CMS-359 Comprehensive Outpatient Rehab Facility Request Form CMS-359.Revised.05.29.20.pdf	Form and Instruction
CMS-360 COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY SURVEY CMS-360. Updated. 05.29.20.pdf	Form and Instruction
CMS-360 COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY SURVEY CMS-360. Updated. 05.29.20.pdf	Form and Instruction
CMS-359 Crosswalk 05.06.20.pdf CMS-359 crosswalk	IC Document
CMS-359 Crosswalk 05.06.20.pdf CMS-359 crosswalk	IC Document
CMS-360 Crosswalk 05.06.20.pdf CMS-360 crosswalk	IC Document
CMS-360 Crosswalk 05.06.20.pdf CMS-360 crosswalk	IC Document

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:

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-359				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-360				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	18	-32	50
Annual IC Time Burden (Hours)	76	-47	123
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-359 crosswalk		09/10/2020
CMS-360 crosswalk		09/10/2020

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].