View Information Collection (IC)

View Information Collection (IC)

Inpatient Rehabilitation Facility - Patient Assessment Instrument
 
No New
 
Required to Obtain or Retain Benefits
 

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 IRF-PAI Voluntary Mandatory Chart 02-20-2014.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10036 IRF-PAI instrument IRF-PAI_Oct_2014_v4.pdf Yes Yes Fillable Fileable

Health Health Care Services

Inpatient Rehabilitation Facility - Patient Assessment Instrument  71 FR 67143

1,161 194
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 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
Crosswalk - Admissions CMS Crosswalk- IRF-PAI 2014 Admission v2.doc 02/28/2014
Crosswalk - Discharge CMS Crosswalk- IRF-PAI 2014 Discharge v2.doc 02/28/2014
Infulenza Burden Pt Influenza Measure. Burden Calculation. 03.21.13.docx 02/28/2014
Pressure Ulcer Burden PU Burden Calculation. 03.26.13.docx 02/28/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.