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OMB Control No:	ICR Reference No: 202604-0938-009
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Inpatient Psychiatric Facility-Patient Assessment Instrument under the Inpatient Psychiatric Facility Quality Reporting Program (CMS-10954)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 05/19/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	2,098,888	0
Time Burden (Hours)	514,228	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to New Statute
Annual Number of Responses	2,098,888	2,098,888
Annual Time Burden (Hours)	514,228	514,228
Annual Cost Burden (Dollars)	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: New Collection, the FY 2027 IPF PPS proposed rule proposes to implement the IPF-PAI as the assessment instrument for the submission of standardized patient assessment data as required by sections 1886(s)(4)(A) and (E) of the Social Security Act.

Annual Cost to Federal Government: $2,289,072

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. Yes

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. Yes

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: Stephan McKenzie 410 786-1943 stephan.mckenzie@cms.hhs.gov

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