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Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)

IC 8848 under ICR 202303-0938-006 · OMB 0938-0986.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-437 A REHABILITATION UNIT CRITERIA WORK SHEET CMS-437A.11.23.22.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-437B REHABILITATION HOSPITAL CRITERIA WORK SHEET CMS437B. 11.21.22.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

497 0
   
Private Sector Businesses or other for-profits
 
   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 497 0 -629 0 1,126 0
Annual IC Time Burden (Hours) 497 0 -629 0 1,126 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
crosswalk Change Crosswalk for CMS-437a form. 04.18.23.docx 04/19/2023
crosswalk Change Crosswalk for CMS-437b form. 04.18.23.docx 04/19/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.