Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data collection)

IC 43666 under ICR 201502-0938-004 · OMB 0938-0760.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-245 OASIS-C1 ICD-9 Medicare and Medicaid OASIS Collection Requirements (Data collection)	Form and Instruction
CMS-R-245 OASIS-C1 ICD-9 Attachement C Final-OASIS-C1-ICD-9-Version-Item-Set-effective-01-01-2015.pdf	Form and Instruction
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
Attachment A OASIS C to C1 Items Timepoints and Uses 11-11-14.pdf Attachment A OASIS C to OASIS C-1 Comparison	IC Document

IC Title:

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-245				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 B - OASIS-C1 to OASIS-C1/ICD-9		09/03/2014
Attachment A OASIS C to OASIS C-1 Comparison		02/12/2015

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

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