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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

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.