Information Collection

COT Preparation, Coding, and Transmission

IC 197759 under ICR 201105-0938-007 · OMB 0938-1140.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1140 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10387 COT Preparation, Coding, and Transmission Form and Instruction
CMS-10387 MINIMUM DATA SET (MDS) - Version 3.0 RESIDENT ASSESSMENT CMS-10387.Instrument.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	COT Preparation, Coding, and Transmission	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10387	MINIMUM DATA SET (MDS) - Version 3.0 RESIDENT ASSESSMENT AND CARE SCREENING -Nursing Home and Swing Bed OMRA (NO/SO) Item Set	CMS-10387.Instrument.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,266	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 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	955,734	955,734
Annual IC Time Burden (Hours)	987,560	987,560
Annual IC Cost Burden (Dollars)	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.