Information Collection

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

IC 182822 under ICR 200711-0938-011 · OMB 0938-1040.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.