Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
DATA COLLECTION FOR ADMINISTERING THE MEDICARE CONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (IRF) Removed 0 0 0 Form and Instruction CMS-10243 CARE Tool
DATA COLLECTION FOR ADMINISTERING THE MEDICARE CONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (volunteers) Removed 0 0 0 Form and Instruction CMS-10243 CARE Tool
DATA COLLECTION FOR ADMINISTERING THE MEDICARECONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (Acute) Removed 0 0 0 Form and Instruction CMS-10243 CARE Tool
DATA COLLECTION FOR ADMINISTERING THE MEDICARECONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (HHA) Removed 0 0 0 Form and Instruction CMS-10243 CARE Tool
DATA COLLECTION FOR ADMINISTERING THE MEDICARECONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (LTCH) Removed 0 0 0 Form and Instruction CMS-10243 CARE Tool
DATA COLLECTION FOR ADMINISTERING THE MEDICARECONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (SNF) Removed 0 0 0 Form and Instruction CMS-10243 CARE Tool
Functional Assessment Standardized Items (FASI): Round 1 New 1570 785 0 Instruction
Form and Instruction CMS-10243 Consent Form
Form and Instruction CMS-10243 Functional Assessment Standardized Items (FASI)
Functional Assessment Standardized Items (FASI): Round 2 New 4080 2040 0 Form and Instruction CMS-10243 Functional Assessment Standardized Items (FASI)
Total burden requested under this ICR: 5650 2825 0  
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