View Information Collection (IC)

View Information Collection (IC)

IC Title:	Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 412 Subpart P

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10036	IRF PAI Instrument	CMS-10036.Draft IRF-PAI Instrument.pdf		Yes	No	Fillable Fileable
Instruction			CMS-10036.IRF-PAI pressure ulcer instructions for PRA.docx		Yes	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: : Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) System of Records, System No. 09-70-1518	FR Citation: 66 FR 56681

Number of Respondents: 9	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	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	0	0	-3,330	0	0	3,330
Annual IC Time Burden (Hours)	0	0	-2,831	0	0	2,831
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10036_IRF-PAI_Revisions Crosswalk	CMS-10036_IRF-PAI_Revisions Crosswalk.docx	06/01/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.