OMB control number
(CMS-437A and 437B) Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations
OMB 0938-0986 · HHS/CMS.
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 2026-09-30 and is listed under ICR 202303-0938-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202303-0938-006 | Reinstatement with change of a previously approved collection | 2023-04-21 | Approved with change | |
| 201906-0938-011 | Reinstatement with change of a previously approved collection | 2019-07-02 | Approved without change | |
| 201507-0938-014 | Revision of a currently approved collection | 2015-07-28 | Approved with change | |
| 201206-0938-010 | Revision of a currently approved collection | 2012-06-30 | Approved with change | |
| 200903-0938-012 | Extension without change of a currently approved collection | 2009-03-31 | Approved without change | |
| 200601-0938-009 | New collection (Request for a new OMB Control Number) | 2006-01-24 | Approved without change |