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: 0938-0267	ICR Reference No: 202505-0938-015
Status: Active	Previous ICR Reference No: 202009-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Comprehensive Outpatient Rehabilitation Facility (CORF) Certification and Survey Forms (CMS-359/360)
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: 09/28/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/04/2025
Terms of Clearance: CMS should improve their monitoring of expiring information collections to avoid unnecessary reinstatement requests and to avoid PRA violations.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2028	36 Months From Approved
Responses	28	0	0
Time Burden (Hours)	238	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses	28	10	18
Annual Time Burden (Hours)	238	162	76
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: • The number of respondents has decreased from 10 respondents in the previous PRA package to 3 respondents in the current PRA package. This is a decrease of 7 respondents annually for the CMS-359 form. • The total annual time burden for the CMS-359 form in the previous PRA package was 10 hours, however, in the current PRA package this time burden is 3 hours. This is a decrease of 7 hours annually in the total annual time burden for the CMS-359 form. • The number of respondents for the CMS-360 form has increased. More specifically, the number of respondents has increased from 8 in the last PRA package to 28 in this PRA package. This is an increase of 20 respondents annually. • The total annual time burden for the CMS-360 form on the previous PRA package was 66 hours, however, in the current PRA package the total annual time burden is 238 hours. This is a decrease of 172 hour annually.

Annual Cost to Federal Government: $434

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? No

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