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Federal forms, ICRs, and supporting documents

Information Collection

Inpatient Rehabilitation Facility - Patient Assessment Instrument

IC 210555 under ICR 202604-0938-006 · OMB 0938-0842.

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

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Inpatient Rehabilitation Facility - Patient Assessment Instrument
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10036 IRF- PAI version 4.2 IRF-PAI-Version-4.2-Effective-10-01-24-v3_clean.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10036 IRF- PAI version 4.4 IRF-PAI-Version-4.4.docx Yes Yes Fillable Fileable

Health Health Care Services

Inpatient Rehabilitation Facility - Patient Assessment Instrument  71 FR 67143

1,175 194
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 660,788 0 0 38,488 0 622,300
Annual IC Time Burden (Hours) 1,156,379 0 0 -22,877 0 1,179,256
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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