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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10036 IRF- PAI version 4.4	Form and Instruction	Modified	Available
Form CMS-10036 IRF- PAI version 4.2	Form and Instruction	Modified	Available
Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Modified	Repair queued
CMS_10036_Supporting_Statement_A.docx	Supporting Statement A	Uploaded 2025-05-07	Available
CMS_10036_Supporting_Statement_A.docx	Supporting Statement A	Uploaded 2025-05-07	Repair queued
Crosswalk_IRF-PAI_versions_4.3_and_4.4.docx	Supplementary Document	Uploaded 2025-05-07	Available
Crosswalk_IRF-PAI_versions_4.3_and_4.4.docx	Supplementary Document	Uploaded 2025-05-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Modified	IRF- PAI version 4.4
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Modified	IRF- PAI version 4.2
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Modified
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Instruction	Modified

ICR Details

OMB Control No: 0938-0842	ICR Reference No: 202505-0938-002
Status: Historical Inactive	Previous ICR Reference No: 202408-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: IRF-PAI for the collection of data pertaining to the Inpatient Rehabilitation Facility Prospective Payment System and Quality Reporting Program (CMS-10036)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 07/08/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/07/2025
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2027	36 Months From Approved	10/31/2027
Responses	571,151	0	571,151
Time Burden (Hours)	1,194,814	0	1,194,814
Cost Burden (Dollars)	0	0	0

---

Abstract: The Centers for Medicare & Medicaid Services (CMS) is requesting approval of revisions to the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) Version 4.1 that will be effective on October 1, 2024. On April 7, 2023 the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) (88 FR 20950) which proposes modifications to the collection of quality reporting data in the Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP). Specifically, CMS proposes to adopt two new measures and remove three measures from the IRF QRP. Per the NPRM, CMS proposes to require IRFs to start collecting assessment data using the IRF-PAI Version 4.2 for IRF patients beginning October 1, 2024.

---

Authorizing Statute(s): PL: Pub.L. 105 - 1 4421 Name of Law: Prospective Payment for Inpatient Rehab Hospital Services
   PL: Pub.L. 111 - 148 3004 Name of Law: Quality Reporting for Long-Term Care Hospitals, etc.
   US Code: 42 USC 1395ww(jX2)(d) Name of Law: Prospective Payment for Inpatient Rehab Services
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV48	Proposed rulemaking	90 FR 18534	04/30/2025

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Inpatient Rehabilitation Facility - Patient Assessment Instrument	CMS-10036, CMS-10036	IRF- PAI version 4.2 ,   IRF- PAI version 4.4

---

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: Burden has decreased due to the removal of five items from the IRF-PAI version 4.4 which include, O0350. Patient’s COVID-19 vaccination is up to date, R0310. Living Situation, R0320A. and R0320B. Food, and • R0330. Utilities. CMS We estimates a decrease in the amount of time it will take to complete a single IRF PAI Version 4.4 as compared to the previously approved package.

---

Annual Cost to Federal Government: $3,319,952

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.     Yes

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.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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

---

Common Form ICR:  No

---

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: 05/07/2025

---