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Federal forms, ICRs, and supporting documents

Information Collection

Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...

IC 7917 under ICR 202505-0938-015 · OMB 0938-0267.

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

View Information Collection (IC)

Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...
 
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-359 Comprehensive Outpatient Rehab Facility Request Form CMS-359 .12.15.23.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-360 COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY SURVEY REPORT CMS-360. 09..11.24.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

28 0
   
State, Local, and Tribal Governments
 
   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 28 0 10 0 18 0
Annual IC Time Burden (Hours) 238 0 162 0 76 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-360 crosswalk Change Crosswalk for CMS.360. 11.05.24.docx 05/30/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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