View Information Collection Request (ICR) Package

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: 0938-0986	ICR Reference No: 201206-0938-010
Status: Historical Active	Previous ICR Reference No: 200903-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations at 42 CFR 412.20-412.30 (CMS-437A&B)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/31/2012
	Date Received in OIRA: 06/30/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved	08/31/2012
Responses	1,164	0	1,227
Time Burden (Hours)	291	0	307
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,164	1,227	-63
Annual Time Burden (Hours)	291	307	-16
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden estimate has been adjusted to account for the reduced number of respondents: 1,227 in 2009 and 1,164 in 2012. The change was at the discretion of the providers and was not caused by any statutory or regulatory change. Although CMS revised a few items for guidance on Forms CMS-437A and CMS-437B, there were no burden changes resulting from those revisions.

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.