Information Collection

Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-306				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 %

table that charts list of burden
	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

table that charts IC Documents
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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