Psychiatric Unit Criteria Work Sheet, Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet, and Supporting Regulations at 42 CFR 488.26

Psychiatric Unit Criteria Work Sheet and Supporting Regulations in 42 CFR 412.25 and 412.27 (CMS-437)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0358 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-437 Psychiatric Unit Criteria Work Sheet, Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet, and Supporting Regulations at 42 CFR 488.26 Form and Instruction
CMS-437 Psychiatric Unit Criteria Worksheet CMS-437 form & guidance.tif Form and Instruction

Information Collection (IC) Details

IC Title:	Psychiatric Unit Criteria Work Sheet, Rehabilitation Unit Criteria Work Sheet and Rehabilitation Hospital Criteria Work Sheet, and Supporting Regulations at 42 CFR 488.26	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 412.25-27

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-437	Psychiatric Unit Criteria Worksheet	CMS-437 form & guidance.tif		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,333	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,333	1,333
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	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.