(CMS-10545) Outcome and Assessment Information Set (OASIS) OASIS–C1/ICD–10

Forms and Documents

Document Name	Status
Form CMS-10545 Medicare and Medicaid Programs OASIS Collection Requirement (Training) Form and Instruction	New
Form CMS-10545 Medicare and Medicaid OASIS Collection Requirements (Data Collection) Form and Instruction	New
CMS-10545 Final Supporting Statement_OASISC1_ICD10. docx.docx Supporting Statement A	2015-04-06

IC Document Collections

IC ID	Document Title	Status
215973	Medicare and Medicaid Programs OASIS Collection Requirement (Training) Form and Instruction	New
215972	Medicare and Medicaid OASIS Collection Requirements (Data Collection) Form and Instruction	New

ICR Details

OMB Control No: 0938-1279	ICR Reference No: 201503-0938-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: (CMS-10545) Outcome and Assessment Information Set (OASIS) OASIS–C1/ICD–10
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/29/2015
	Date Received in OIRA: 04/06/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved
Responses	17,280,904	0	0
Time Burden (Hours)	15,320,253	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for OMB PRA approval of a version upgrade of the Outcome and Assessment Information Set (OASIS-C1/ICD-9). The upgraded version of the OASIS item set is titled OASIS -C1/ICD-10.

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Authorizing Statute(s): PL: Pub.L. 109 - 171 5201(c)(2) Name of Law: Deficit Reduction Act of 2005: Home health - pay for reporting of quality information
   PL: Pub.L. 105 - 33 4601(e) Name of Law: Balanced Budget Act of 1997
   US Code: 42 USC 1395x Name of Law: Definitions of Services, Institutions,etc: Home Health Agency
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 1419	01/09/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 15796	03/25/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Medicare and Medicaid OASIS Collection Requirements (Data Collection)	CMS-10545	OASIS-C1 ICD-10 Item Set
Medicare and Medicaid Programs OASIS Collection Requirement (Training)	CMS-10545	OASIS-C1 ICD10 Item Set

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	17,280,904	0	0	17,280,904	0	0
Annual Time Burden (Hours)	15,320,253	0	0	15,320,253	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection for OASIS-C1 ICD-10.

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Annual Cost to Federal Government: $1,500,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/06/2015

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