Information Collection

Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities

IC 8633 under ICR 202602-0938-004 · OMB 0938-0833.

Documents and Forms

Document Name Document Type
Form CMS-R-306 Death Reporting Worksheet Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities Form
CMS-R-306 Death Reporting Worksheet deathreportingworksheet PRA disclosure OMB updates 5-17-19.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 483.350 - 483.376

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-306	Death Reporting Worksheet	deathreportingworksheet PRA disclosure OMB updates 5-17-19.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 366	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

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	1,376,621	22,628	1,353,993
Annual IC Time Burden (Hours)	439,623	24,679	414,944
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.

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