(CMS-437) Psychiatric Unit Criteria Work Sheet and Supporting Regulations

ICR 202106-0938-002

OMB: 0938-0358

Federal Form Document

ICR Details
0938-0358 202106-0938-002
Received in OIRA 201712-0938-004
(CMS-437) Psychiatric Unit Criteria Work Sheet and Supporting Regulations
Revision of a currently approved collection   No
Regular 06/01/2021
  Requested Previously Approved
36 Months From Approved 06/30/2021
1,598 1,616
1,732 1,212
0 0

The psychiatric unit criteria work sheets are necessary to verify, on an annual basis, that these units meet the requirements to be excluded from payment under the Medicare Inpatient Prospective Payment System (IPPS) for the purpose of receiving payment under the Inpatient Psychiatric Prospective Payment System (IPF PPS).

US Code: 42 USC 412 Name of Law: 25-27

Not associated with rulemaking

  86 FR 14926 03/19/2021
86 FR 29264 06/01/2021

  Total Request 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 1,598 1,616 0 0 -18 0
Annual Time Burden (Hours) 1,732 1,212 0 0 520 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
The total annual burden hours have increase by 520 hours and the total annual cost burden has increased by $39,286. This increase is due to two factors. First we updated the burden calculations to include the time and cost burden required for a medical secretary to process the CMS-437 form after it has been completed. See section 12(b) for a list of the tasks that would be performed by the medical secretary. This time and cost burden was not included in the previous PRA package, but is a necessary part of the completion of the CMS-437

Denise King 410 786-1013 [email protected]


On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

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