SNF Resident Assessment MDS Data and Supporting Regulations at 42 CFR 413.337, 413.343 and 424.32, and 483.20

MPAF Data and Supporting Regulations in 42 CFR Sections 413.337, 413.343, 424.32 and 483.20

Documents and Forms

Document Name Document Type
Form CMS-R-250 SNF Resident Assessment MDS Data and Supporting Regulations at 42 CFR 413.337, 413.343 and 424.32, and 483.20 Form
MDS20MDSAllForms 32.pdf Other-Form page 2
MDS20MDSAllForms 33.pdf Other-Form page 3
MDS20MDSAllForms 34.pdf Other-Form page 4
MDS20MDSAllForms 35.pdf Other-Form page 5
CMS-R-250 MDS Medicare PPS Assessment Form MDS20MDSAllForms 31.pdf Form

Information Collection (IC) Details

IC Title:	SNF Resident Assessment MDS Data and Supporting Regulations at 42 CFR 413.337, 413.343 and 424.32, and 483.20	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 413.337 42 CFR 413.343 42 CFR 424.32 42 CFR 483.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-250	MDS Medicare PPS Assessment Form	MDS20MDSAllForms 31.pdf	Yes	Yes	Paper Only
Other-Form page 2			MDS20MDSAllForms 32.pdf	Yes	Yes	Paper Only
Other-Form page 3			MDS20MDSAllForms 33.pdf	Yes	Yes	Paper Only
Other-Form page 4			MDS20MDSAllForms 34.pdf	Yes	Yes	Paper Only
Other-Form page 5			MDS20MDSAllForms 35.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,302	Number of Respondents for Small Entity: 1,583

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,647,010	-1,072,108	4,719,118
Annual IC Time Burden (Hours)	2,572,236	-712,011	3,284,247
Annual IC Cost Burden (Dollars)	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.