Information Collection

Medicare and Medicaid Programs OASIS Collection Requirements (Data collection)

IC 43666 under ICR 200908-0938-002 · OMB 0938-0760.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0760 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-245 Medicare and Medicaid Programs OASIS Collection Requirements (Data collection)	Form and Instruction
CMS-R-245 CMS-R-245.OASIS Instrument CMS-R-245 OASIS-C PRA - OASIS-C Ver12.1 2-24-2009.pdf	Form and Instruction

IC Title:

Medicare and Medicaid Programs OASIS Collection Requirements (Data collection)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 484.250 42 CFR 484.55 42 CFR 484.205 42 CFR 484.245

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-245	CMS-R-245.OASIS Instrument	CMS-R-245 OASIS-C PRA - OASIS-C Ver12.1 2-24-2009.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Home Health Agency (HHA) Outcome and Assessment Information Set (OASIS), HHS/CMS/CMSO (System # 09-70-0522)

FR Citation: 72 FR 63906

Number of Respondents: 10,170

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: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	14,777,010	14,777,010
Annual IC Time Burden (Hours)	14,858,370	14,858,370
Annual IC Cost Burden (Dollars)	0	0

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.