Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...

Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64... (CMS-359/360)

⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-360 Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64... Form
CMS-360 CORF Survey Report CMS-360.pdf Form
CMS-359 CORF Request for Certification to Participate in the Med CMS-359 [rev 09-18-2012].pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Information Collection Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-360	CORF Survey Report	CMS-360.pdf		Yes	No	Fillable Printable
Form and Instruction	CMS-359	CORF Request for Certification to Participate in the Medicare Program	CMS-359 [rev 09-18-2012].pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 295	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	42	0	-18	60
Annual IC Time Burden (Hours)	137	-223,085	-63	223,285
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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