OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Review Choice Demonstration for Inpatient Rehabilitation Facility Services

IC 249216 under ICR 202507-0938-027 · OMB 0938-1420.

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

View Information Collection (IC)

Review Choice Demonstration for Inpatient Rehabilitation Facility Services CPI-10765
 
No Modified
 
Voluntary
 
42 CFR 402(a)(1)(J)  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10765 Review Choice Demonstration for Inpatient Rehabilitation Facility Services CMS-10765 - IRF Instrument.docx Yes No Fillable Fileable

Health Health Care Services

 

237,419 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   99 %

  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 237,419 0 0 57,509 179,910 0
Annual IC Time Burden (Hours) 120,317 0 0 28,784 91,533 0
Annual IC Cost Burden (Dollars) 7,896,556 0 0 1,912,749 5,983,807 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].