IRF-PAI for the collection of data pertaining to the Inpatient Rehabilitation Facility Prospective Payment System and Quality Reporting Program (CMS-10036)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10036 IRF- PAI version 4.4	Form and Instruction	Modified	Available
Form CMS-10036 IRF- PAI version 4.2	Form and Instruction	Modified	Available
CMS-10036.Crosswalk_IRF_PAI_version_4.4_508.docx	Supplementary Document	Uploaded 2026-04-13	Available
CMS_10036_Supporting_Statement_A_IRF-PAI_v4.4 (FY27 proposed rule).docx	Supporting Statement A	Uploaded 2026-04-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Modified	IRF- PAI version 4.4
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Modified	IRF- PAI version 4.2

ICR Details

OMB Control No: 0938-0842	ICR Reference No: 202604-0938-006
Status: Received in OIRA	Previous ICR Reference No: 202508-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: IRF-PAI for the collection of data pertaining to the Inpatient Rehabilitation Facility Prospective Payment System and Quality Reporting Program (CMS-10036)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/13/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2027
Responses	660,788	622,300
Time Burden (Hours)	1,156,379	1,179,256
Cost Burden (Dollars)	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) is requesting an extension to the approval of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) Version 4.4 that will be effective on October 1, 2026. Specifically, we are proposing to change the data submission deadlines for data submitted for the purposes of the IRF QRP. If finalized as proposed, these updates would not add any additional collection burden for IRFs. CMS is asking for an extension of the approval of the IRF-PAI Version 4.4, which will have an October 1, 2026 implementation date. The IRF-PAI Version 4.2 will have a runoff period through September 30, 2026 and sunset when the IRF-PAI Version 4.4 takes effect on October 1, 2026.

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Authorizing Statute(s): PL: Pub.L. 105 - 1 4421 Name of Law: Prospective Payment for Inpatient Rehab Hospital Services
   PL: Pub.L. 111 - 148 3004 Name of Law: Quality Reporting for Long-Term Care Hospitals, etc.
   US Code: 42 USC 1395ww(jX2)(d) Name of Law: Prospective Payment for Inpatient Rehab Services
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV76	Proposed rulemaking	91 FR 17195	04/06/2026

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Inpatient Rehabilitation Facility - Patient Assessment Instrument	CMS-10036, CMS-10036	IRF- PAI version 4.2 ,   IRF- PAI version 4.4

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	660,788	622,300	0	0	38,488	0
Annual Time Burden (Hours)	1,156,379	1,179,256	0	0	-22,877	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no changes to burden since the approval of the IRF-PAI v4.4 was approved. Additionally, new information demonstrates a change in the number of IRFs. The number of IRFs has increased from 1,166 to 1,175 .

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Annual Cost to Federal Government: $3,384,268

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/13/2026

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