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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0842
ICR Reference No:
200902-0938-004
Status:
Historical Active
Previous ICR Reference No:
200512-0938-008
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
05/29/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/06/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2012
36 Months From Approved
05/31/2009
Responses
396,660
0
390,000
Time Burden (Hours)
337,162
0
421,939
Cost Burden (Dollars)
0
0
0
Abstract:
We are requesting an extension of the existing approval for the assessment instrument that inpatient rehabilitation hospitals and inpatient rehabilitation units of a hospital (herein referred to as IRFs) are required to submit in the manner necessary to administer the payment rate methodology under the IRF PPS described in 42 CFR 412 Subpart P. The burden associated with this requirement is the staff time required to complete, encode and transmit the data from the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI).
Authorizing Statute(s):
US Code:
42 USC 1395ww(jX2)(d)
Name of Law: Prospective Payment for Inpatient Rehab Services
PL:
Pub.L. 105 - 1 4421
Name of Law: Prospective Payment for Inpatient Rehab Hospital Services
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AJ55
Final or interim final rulemaking
66 FR 41324
08/07/2001
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
73 FR 63479
10/24/2008
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 2078
01/14/2009
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P
CMS-10036
Inpatient Rehabilitation Facility - Patient Assessment Instrument
Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P
CMS-10036
Inpatient Rehabilitation Facility - Patient Assessment Instrument
Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P (CMS-10036)
CMS-10036
Inpatient Rehabilitation Facility - Patient Assessment Instrument
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
396,660
390,000
0
0
6,660
0
Annual Time Burden (Hours)
337,162
421,939
0
0
-84,777
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Total responses increased due to a more accurate estimate based upon actual data, not available at the time of the original estimate. Total burnden declined due to a reduction in the number of IRF admissions since fiscal year 2004.
Annual Cost to Federal Government:
$2,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Bonnie Harkless 4107865666
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
02/06/2009
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