Comprehensive Outpatient Rehabilitation Facility Eligibility & Survey Forms And Information Collection Requirements In 42 Cfr 488.56, 488.58, 488.60, 488.64, 488.66 And 405.262

COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY ELIGIBILITY & SURVEY FORMS AND INFORMATION COLLECTION REQUIREMENTS IN 42 CFR 488.56, 488.58, 488.60, 488.64, 488.66 AND 405.262

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0267 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY ELIGIBILITY & SURVEY FORMS AND INFORMATION COLLECTION REQUIREMENTS IN 42 CFR 488.56, 488.58, 488.60, 488.64, 488.66 AND 405.262	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-359	No	No
Form	360	No	No
Form	HCFA-R-55	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	162	62	100
Annual IC Time Burden (Hours)	77,540	30,355	47,185
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.