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Federal forms, ICRs, and supporting documents

Information Collection

Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD)

IC 197759 under ICR 201310-0938-013 · OMB 0938-1140.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 413.343 42 CFR 413.337 42 CFR 424.32 42 CFR 483.20

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10387 Nursing Home PPS (NP) Item Set MDS3 0_NP_PPS_v1 11 1.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10387 Nursing Home OMRA-Start of Therapy and Discharge (NSD) Item Set MDS3 0_NSD_OMRA-SOT-Dschg_v1 11 1.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10387 Nursing Home and Swing Bed OMRA-Start of Therapy (NS/SS) Item Set MDS3 0_NS_SS_OMRA-SOT_v1 11 1.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10387 Nursing Home OMRA-Discharge (NOD) Item Set MDS3 0_NOD_OMRA-Other-Dschg_v1 11 1.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10387 Nursing Home and Swing Bed OMRA (NO/SO) Item Set MDS3 0_NO_SO_OMRA-Other_v1 11 1.pdf Yes Yes Fillable Printable

Health Health Care Services

 

15,376 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 6,396,416 0 5,511,924 0 0 884,492
Annual IC Time Burden (Hours) 6,608,971 0 5,695,087 0 0 913,884
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Crosswalk for Change to MDS 3_PRA_FY2014.docx 10/30/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.