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(437) Psychiatric Unit Criteria Work Sheet, Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet, and Supporting Regulations

IC 7996 under ICR 202106-0938-002 · OMB 0938-0358.

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Form and Instruction
Form and Instruction
Form and Instruction
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(437) Psychiatric Unit Criteria Work Sheet, Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet, and Supporting Regulations
 
No Modified
 
Mandatory
 
42 CFR 412.25-27

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-437 Psychiatric Unit Criteria Worksheet CMS-437 Supporting Statement A . 03.26.21.docx No   Paper Only

Health Health Care Services

 

1,598 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,598 0 0 -18 0 1,616
Annual IC Time Burden (Hours) 1,732 0 0 520 0 1,212
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Exhibit A - Change Crosswalk for CMS-437. 08.31.17.docx 12/05/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.