View Information Collection (IC)

View Information Collection (IC)

Inpatient Rehabilitation Facility - Patient Assessment Instrument
 
No Modified
 
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 IRF-PAI instrument Final IRF-PAI Version 2.0 - Effective October 1 2018.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10036 IRF-PAI Intrument Final IRF-PAI Version 1.5 - Effective October 1 2017.pdf Yes Yes Fillable Fileable

Health Health Care Services

Inpatient Rehabilitation Facility - Patient Assessment Instrument  71 FR 67143

1,137 194
   
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 402,311 0 43,311 0 0 359,000
Annual IC Time Burden (Hours) 227,151 0 30,071 0 0 197,080
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix B: Change table V1.3 to 1.4 Appendix B IRF-PAI v1.3 to v1.4 Change Table.pdf 06/02/2017
Appendix A: IRF-PAI V1.3 Appendix A IRF-PAI_V1.3 effective 10-1-15.pdf 06/02/2017
Appendix B: IRF-PAI V1.4 Appendix B IRF-PAI Version 1.4 - Effective Octobe 1 2016.pdf 06/02/2017
Appendix C: Change Tables V1.4 to 1.5 and V1.5 to 2.0 Appendix C - Proposed IRF-PAI Versions 1.5 and 2.0 Change Tables.pdf 06/02/2017
Crosswalk IRF PRA Package Crosswalk.docx 08/01/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.