Inpatient Rehabilitation Facility - Patient Assessment Instrument

IRF-PAI for the collection of data pertaining to the Inpatient Rehabilitation Facility Prospective Payment System and Quality Reporting Program (CMS-10036)

OMB: 0938-0842

IC ID: 210555

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

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Inpatient Rehabilitation Facility - Patient Assessment Instrument
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10036 IRF- PAI version 4.2 IRF-PAI-Version-4.2-Effective-10-01-24-v3_clean.docx Yes Yes Fillable Fileable
Instruction Final-Specifications-for-IRF-QRP-Quality-Measures-and-SPADEs.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10036 IRF- PAI version 4.3 IRF-PAI-Version-4.3-Effective-10-01-26.docx Yes Yes Fillable Fileable

Health Health Care Services

Inpatient Rehabilitation Facility - Patient Assessment Instrument  71 FR 67143

1,160 194
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 571,151 0 -228,297 0 0 799,448
Annual IC Time Burden (Hours) 1,194,814 0 6,004 0 0 1,188,810
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Crosswalk-IRF-PAI 4.2 to 4.3.docx 08/14/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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