View Information Collection (IC)

View Information Collection (IC)

Inpatient Rehabilitation Facility-Patient Assessment Instrument
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR Subpart P  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10036 Voluntary/Mandatory Items for Proposed DRAFT IRF-PAI Version 1.2 (Proposed DRAFT Effective October 1, 2014) Assessment Quality Indicator Items- Sect 3004 IRF Quality Reporting Program IRF-PAI-VolMandatChart_v3_508.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10036 IRF-PAI Instrument 508c IRF-PAI 2014.pdf Yes Yes Fillable Fileable

Health Health Care Services

Inpatient Rehabilitation Facilities (IRF) Patient Assessment Instrument (IRF-PAI),''   71 FR 67143

1,161 194
   
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 359,000 0 359,000 0 0 0
Annual IC Time Burden (Hours) 197,080 0 197,080 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Pressure Ulcer Burden Calculation PU Burden Calculation. 03.26.13.docx 06/04/2013
Crosswalk - IRF PAI 2014 Admission CMS Crosswalk- IRF-PAI 2014 Admission v2.doc 06/04/2013
Crosswalk - IRF-PAI 2014 Dischare CMS Crosswalk- IRF-PAI 2014 Discharge v2.doc 06/04/2013
Influenza Burden Calculation Pt Influenza Measire. Burden Calculation. 03.21.13.docx 06/05/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.