Information Collection Request
Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities (CMS-10036)
ICR 202304-0938-017 · OMB 0938-0842 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0842 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument |
Form and Instruction | Modified | Repair queued |
 CMS-10036-Supporting-Statement-A-4.2_Changes to 4.1(v10)_clean.docx |
Supporting Statement A | Uploaded 2023-04-27 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 210555 |  Inpatient Rehabilitation Facility - Patient Assessment Instrument |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0842 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202210-0938-004 |
| Agency Tracking No | CCSQ |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |