Testing of Revised OASIS Instrument for Home Health Quality Measures & Data Analysis

Documents and Forms

Document Name Document Type
Form CMS-10238 Testing of Revised OASIS Instrument for Home Health Quality Measures & Data Analysis Form and Instruction
OASIS Form 83 - Part 2_rev_03_06_08.doc Other-Part 2 Form
CMS-10238 CMS-10238 - OASIS Instrument CMS-10238 OASIS-C_ALL_10180 7 instrument.pdf Form and Instruction
CMS-10238 CMS-10238 - OASIS Instrument (Revised) OASIS-C_Pg1_Rev_3-6-08.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Testing of Revised OASIS Instrument for Home Health Quality Measures & Data Analysis	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 484 and 488

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10238	CMS-10238 - OASIS Instrument	CMS-10238 OASIS-C_ALL_10180 7 instrument.pdf	No	No	Printable Only
Form and Instruction	CMS-10238	CMS-10238 - OASIS Instrument (Revised)	OASIS-C_Pg1_Rev_3-6-08.pdf	No		Printable Only
Other-Part 2 Form			OASIS Form 83 - Part 2_rev_03_06_08.doc	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11	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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11	11
Annual IC Time Burden (Hours)	298	298
Annual IC Cost Burden (Dollars)	11,205	11,205

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.