Information Collection Request

Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities (CMS-10036)

ICR 202204-0938-001 · OMB 0938-0842 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument Form and Instruction Unchanged Repair queued
CMS-10036_Response to Comments_v4 4-13-2022.docx Supplementary Document Uploaded 2022-04-13 Repair queued
CMS-10036-Supporting-Statement-A 4-7-22.docx Supporting Statement A Uploaded 2022-04-12 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
210555 Inpatient Rehabilitation Facility - Patient Assessment Instrument Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 12/31/2022
411,081 411,081
704,747 704,747
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Inpatient Rehabilitation Facility - Patient Assessment Instrument CMS-10036 IRF- PAI vesion 4.0

table that charts list of burden
  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 411,081 411,081 0 0 0 0
Annual Time Burden (Hours) 704,747 704,747 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No