Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data collection)

IC 43666 under ICR 201312-0938-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 OASIS Collection Requirements (Data collection)	Form and Instruction
CMS-R-245 OASIS-C1 Revised OASIS-C 1. 09.27.13. 508.pdf	Form and Instruction
OASIS Burden Calculations.09.30.13.docx OASIS Burden Calculations	IC Document
Attachment A. OASIS C to C1 Items Timepoints and Uses.10-01-13.pdf OASIS-C to Draft OASIS C-1 - Items, Timepoints and Uses Crosswalk	IC Document
OASIS-C1 Revisions since 60 day PRA package filing. 10.01.2013.docx Crosswalk	IC Document

IC Title:

Medicare and Medicaid 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 484.55 42 CFR 484.205 42 CFR 484.245 42 CFR 484.250 42 CFR 484.20

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-R-245	OASIS-C1	Revised OASIS-C 1. 09.27.13. 508.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: 12,014

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17,268,890	796,555	16,472,335
Annual IC Time Burden (Hours)	15,224,141	-1,251,867	16,476,008
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OASIS Burden Calculations	OASIS Burden Calculations.09.30.13.docx	11/25/2013
OASIS-C to Draft OASIS C-1 - Items, Timepoints and Uses Crosswalk	Attachment A. OASIS C to C1 Items Timepoints and Uses.10-01-13.pdf	11/25/2013
Crosswalk	OASIS-C1 Revisions since 60 day PRA package filing. 10.01.2013.docx	11/25/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.