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

Comprehensive Outpatient Rehabilitation Facility (CORF) Certification and Survey Forms (CMS-359/360)

Documents and Forms

Document Name Document Type
Form CMS-359 Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64... Form and Instruction
CMS-359 Comprehensive Outpatient Rehab Facility Request Form CMS-359 .12.15.23.pdf Form and Instruction
CMS-360 COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY SURVEY CMS-360. 09..11.24.pdf Form and Instruction
Change Crosswalk for CMS.360. 11.05.24.docx CMS-360 crosswalk IC Document

Information Collection (IC) Details

IC Title:	Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	28	10	18
Annual IC Time Burden (Hours)	238	162	76
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.