Inpatient Psychiatric Facility-Patient Assessment Instrument under the Inpatient Psychiatric Facility Quality Reporting Program (CMS-10954)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10954 IPF-PAI_Discharge	Form and Instruction	Modified	Available
Form CMS-10954 IPF-PAI_Admission	Form and Instruction	Modified	Available
CMS-10954 IPF PAI FY 2027 FR response to public comments.docx	Supplementary Document	Uploaded 2026-09-15	Available
CMS-10954 IPF PAI FY 2027 FR Supporting Statement A_final rule_clean.docx	Supporting Statement A	Uploaded 2026-09-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
279851	Inpatient Psychiatric Facility-Patient (IPF-PAI) Assessment	Form and Instruction	Modified	IPF-PAI_Discharge
279851	Inpatient Psychiatric Facility-Patient (IPF-PAI) Assessment	Form and Instruction	Modified	IPF-PAI_Admission

ICR Details

OMB Control No: 0938-1496	ICR Reference No: 202607-0938-018
Status: Received in OIRA	Previous ICR Reference No: 202604-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Inpatient Psychiatric Facility-Patient Assessment Instrument under the Inpatient Psychiatric Facility Quality Reporting Program (CMS-10954)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/16/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	2,098,888	0
Time Burden (Hours)	419,778	0
Cost Burden (Dollars)	0	0

---

Abstract: The requirements of the Inpatient Psychiatric Facility (IPF) Quality Reporting Program are set forth under section 1886(s)(4) of the Social Security Act. Under the IPF Quality Reporting Program, starting in fiscal year (FY) 2014, Inpatient Psychiatric Facilities (IPFs) must submit pre-defined quality measures to the Centers for Medicare & Medicaid Services (CMS). IPFs that do not report on the selected quality measures and comply with other program requirements will have their IPF prospective payment system (PPS) payment updates reduced by 2.0 percentage points. In the FY 2027 IPF PPS Final rule, we proposed to implement the IPF-PAI as the assessment instrument for the submission of standardized patient assessment data as required by sections 1886(s)(4)(A) and (E) of the Social Security Act for all patients aged 12 and older to fulfill the requirements of section 4125(b) of the CAA, 2023.

---

Authorizing Statute(s): US Code: 42 USC 1395ww Name of Law: PAYMENT TO HOSPITALS FOR INPATIENT HOSPITAL SERVICES
  

Citations for New Statutory Requirements: US Code: 42 USC 1395ww Name of Law: PAYMENT TO HOSPITALS FOR INPATIENT HOSPITAL SERVICES

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV77	Final or interim final rulemaking	91 FR 48514	07/31/2026

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Inpatient Psychiatric Facility-Patient (IPF-PAI) Assessment	CMS-10954, CMS-10954	IPF-PAI_Admission ,   IPF-PAI_Discharge

---

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	2,098,888	0	2,098,888	0	0	0
Annual Time Burden (Hours)	419,778	0	419,778	0	0	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: New collection

---

Annual Cost to Federal Government: $2,413,293

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]? No

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

---

Common Form ICR:  No

---

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: 09/16/2026

---