(CMS-437A and 437B) Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations

OMB 0938-0986

The rehabilitation hospital and rehabilitation unit criteria work sheets are necessary to verify that these facilities/units comply and remain in compliance with the exclusion criteria for the Medicare perspective payment system.

The latest form for (CMS-437A and 437B) Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations expires 2022-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-437 A Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B) Form and Instruction
Responses to Comments.11.18.22.docx Supplementary Document
CMS 437A-B.SupportingStatementPart A. 4-20-23.docx Supporting Statement A
Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B) Form and Instruction

All Historical Document Collections

202303-0938-006 Approved with change	Reinstatement with change of a previously approved collection	2023-04-21
201906-0938-011 Approved without change	Reinstatement with change of a previously approved collection	2019-07-02
201507-0938-014 Approved with change	Revision of a currently approved collection	2015-07-28
201206-0938-010 Approved with change	Revision of a currently approved collection	2012-06-30
200903-0938-012 Approved without change	Extension without change of a currently approved collection	2009-03-31
200601-0938-009 Approved without change	New collection (Request for a new OMB Control Number)	2006-01-24