IRF-PAI for the collection of data pertaining to the Inpatient Rehabilitation Facility Prospective Payment System and Quality Reporting Program (CMS-10036)

ICR 202505-0938-002

OMB: 0938-0842

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument Form and Instruction	Modified
CMS_10036_Supporting_Statement_A.docx Supporting Statement A	2025-05-07
Crosswalk_IRF-PAI_versions_4.3_and_4.4.docx Supplementary Document	2025-05-07

IC Document Collections

IC ID	Document Title	Status
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument Form and Instruction	Modified