Review Choice Demonstration for Inpatient Rehabilitation Facility Services

Pre-Claim Review Demonstration for Inpatient Rehabilitation Facility Services (CMS-10765)

OMB: 0938-1420

IC ID: 249216

Information Collection (IC) Details

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Review Choice Demonstration for Inpatient Rehabilitation Facility Services CPI-10765
 
No New
 
Voluntary
 
42 CFR 402(a)(1)(J)  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10765 Review Choice Demonstration for Inpatient Rehabilitation Facility Services CMS-10765-IRF PRA Instrument (508).pdf Yes No Fillable Fileable

Health Health Care Services

 

179,910 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   99 %

  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 179,910 179,910 0 0 0 0
Annual IC Time Burden (Hours) 91,533 91,533 0 0 0 0
Annual IC Cost Burden (Dollars) 5,983,807 5,983,807 0 0 0 0

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