Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data Collection)

IC 215972 under ICR 201503-0938-011 · OMB 0938-1279.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1279 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10545 Medicare and Medicaid OASIS Collection Requirements (Data Collection) Form and Instruction
CMS-10545 OASIS-C1 ICD-10 Item Set OASIS-C1_ICD-10_2015_1_29.pdf Form and Instruction
Attachment A_Item revisions.pdf Attachment A OASIS C1/ICD-9 to OASIS C1/ICD-10 changes IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare and Medicaid OASIS Collection Requirements (Data Collection)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 484.55 42 CFR 484.205 42 CFR 484.20 42 CFR 484.250 42 CFR 484.245

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10545	OASIS-C1 ICD-10 Item Set	OASIS-C1_ICD-10_2015_1_29.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 Asessment 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 %

	Approved	Program Change Due to Agency Discretion
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

Title	Document	Date Uploaded
Attachment A OASIS C1/ICD-9 to OASIS C1/ICD-10 changes	Attachment A_Item revisions.pdf	04/06/2015

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