(CMS-437A and 437B) Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-437B REHABILITATION HOSPITAL CRITERIA WORK SHEET	Form and Instruction	Modified	Available
Form CMS-437 A REHABILITATION UNIT CRITERIA WORK SHEET	Form and Instruction	Modified	Available
Form CMS-437 A Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)	Form and Instruction	Modified	Repair queued
Responses to Comments.11.18.22.docx	Supplementary Document	Uploaded 2023-03-31	Repair queued
CMS 437A-B.SupportingStatementPart A. 4-20-23.docx	Supporting Statement A	Uploaded 2023-04-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8848	Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)	Form and Instruction	Modified	REHABILITATION HOSPITAL CRITERIA WORK SHEET
8848	Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)	Form and Instruction	Modified	REHABILITATION UNIT CRITERIA WORK SHEET
8848	Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0986	ICR Reference No: 202303-0938-006
Status: Active	Previous ICR Reference No: 201906-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: (CMS-437A and 437B) Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/30/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/21/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	36 Months From Approved
Responses	497	0	0
Time Burden (Hours)	497	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The rehabilitation hospital and rehabilitation unit criteria work sheets are necessary to verify that these facilities/units comply and remain in compliance with the exclusion criteria for the Medicare perspective payment system.

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Authorizing Statute(s): US Code: 42 USC 412.20 Name of Law: Hospital Services Subject to PPS
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 48482	08/09/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 15036	03/10/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)	CMS-437B, CMS-437 A	REHABILITATION UNIT CRITERIA WORK SHEET ,   REHABILITATION HOSPITAL CRITERIA WORK SHEET

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	497	0	0	-629	0	1,126
Annual Time Burden (Hours)	497	0	0	-629	0	1,126
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There has been a significant decrease across all the numbers for this PRA package. For example, the number of responses has decreased by 629. The total annual time burden has decreased by 629 hours and the total annual cost burden has decreased by $65,618.We believe that the decreased number of responses and total annual burden hours is due to an overestimate in the number of responses in the previous PRA package. We say this because, in the previous PRA package, it stated that there were 1,126 total responses. However, in 2017, there were only 258 existing and 6 new IRF hospitals. Also, in 2017, there was only 1 new and 1,150 existing IRF units. In addition, as the CMS 437A form is only submitted every 3 years by the existing IRF units, only approximately 383 out of the existing 1,150 IRF units would be submitting the CMS-437A form each year. Therefore, at the time of submission of the previous PRA package, there should have been only about 648 annual respondents. (258 existing IRF hospitals + 6 new IRF hospitals + 1 new IRF unit + 383 existing IRF units submitted annually = 648).

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Annual Cost to Federal Government: $27,827

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/21/2023

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