View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0986	ICR Reference No: 201906-0938-011
Status: Historical Active	Previous ICR Reference No: 201507-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: (CMS-437A and 437B) Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/19/2019
	Date Received in OIRA: 07/02/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2022	36 Months From Approved
Responses	1,126	0	0
Time Burden (Hours)	1,126	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,126	648	478
Annual Time Burden (Hours)	1,126	1,006	120
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: No

Burden Reduction Due to:

Short Statement: In the previous PRA package, the total number of IRF units and hospitals was stated to be 478. At this time, there are 846 IRF units and 280 IRF hospitals, which combined adds up to a total number of 1,126 IRFs. The number of IRFs have increased by 648 since the last PRA package was filed. The increased number of IRFs contributes to the increased time and cost burden stated in this PRA package. Also, we have increased the estimated time burden for completion of the CMS-437A and CMS-437B forms to 45 minutes per form. This increased time burden estimate contributes to the increased time and cost burdens stated in this PRA package.

Annual Cost to Federal Government: $5,209

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: Denise King 410 786-1013 Denise.King@cms.hhs.gov

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