Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data collection)

IC 43666 under ICR 201409-0938-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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-345 Medicare and Medicaid OASIS Collection Requirements (Data collection)	Form and Instruction
CMS-R-345 OASIS C-1 / ICD-9 OASIS-C1_ICD9_All_Items.508. 08.07.14.pdf	Form and Instruction
Attachment A. OASIS C to C1 Items Timepoints and Uses.10-01-13.pdf Attachment A OASIS-C to OASIS C-1 crosswalk	IC Document
Attachment B.Table of Changes to OASIS-C1 to Create ICD 9 Version. 07.28.14.docx Attachment B - OASIS-C1 to OASIS-C1/ICD-9	IC Document
OASIS Burden Calculations 08 20 14.docx OASIS Burden Calculation	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 484.245 42 CFR 484.205 42 CFR 484.250 42 CFR 484.55 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-345	OASIS C-1 / ICD-9	OASIS-C1_ICD9_All_Items.508. 08.07.14.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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	17,268,890	17,268,890
Annual IC Time Burden (Hours)	15,224,141	15,224,141
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A OASIS-C to OASIS C-1 crosswalk	Attachment A. OASIS C to C1 Items Timepoints and Uses.10-01-13.pdf	09/03/2014
Attachment B - OASIS-C1 to OASIS-C1/ICD-9	Attachment B.Table of Changes to OASIS-C1 to Create ICD 9 Version. 07.28.14.docx	09/03/2014
OASIS Burden Calculation	OASIS Burden Calculations 08 20 14.docx	09/03/2014

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