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Federal forms, ICRs, and supporting documents

Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data collection)

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

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

View Information Collection (IC)

Medicare and Medicaid OASIS Collection Requirements (Data collection)
 
No Modified
 
Mandatory
 
42 CFR 484.245 42 CFR 484.205 42 CFR 484.250 42 CFR 484.55 42 CFR 484.20

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 ICD-9 Attachement C Final-OASIS-C1-ICD-9-Version-Item-Set-effective-01-01-2015.pdf Yes Yes Fillable Fileable

Health Health Care Services

Home Health Agency (HHA) Outcome and Assessment Information Set (OASIS), HHS/CMS/CMSO (System # 09-70-0522)  72 FR 63906

12,014 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 17,268,890 0 0 0 0 17,268,890
Annual IC Time Burden (Hours) 15,224,141 0 0 0 0 15,224,141
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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
Attachment A OASIS C to OASIS C-1 Comparison Attachment A OASIS C to C1 Items Timepoints and Uses 11-11-14.pdf 02/12/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.