Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data Collection)

IC 215972 under ICR 201607-0938-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10545 Medicare and Medicaid OASIS Collection Requirements (Data Collection)	Form and Instruction
CMS-10545.OASIS C2 - Guidance Manual.docx	Instruction
CMS-10545 OASIS-C2 ICD-10 Item Set ApndxB-OASIS-C2ItemSet.pdf	Form and Instruction
Appendix A OASISICD10-OASISc2 Change Table final 3-15-16 SXF (3).docx OASIS C-2/ICD-10 Change (Crosswalk)	IC Document
OASIS-C2 Guidance Manual 6-17-16.pdf OASIS-C2 Manual	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 484.205 42 CFR 484.20 42 CFR 484.250 42 CFR 484.55 42 CFR 484.245

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-10545	OASIS-C2 ICD-10 Item Set	ApndxB-OASIS-C2ItemSet.pdf		Yes	Yes	Fillable Fileable
Instruction			CMS-10545.OASIS C2 - Guidance Manual.docx		Yes	No	Printable Only

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: 12,198

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17,900,000	631,110	17,268,890
Annual IC Time Burden (Hours)	15,714,927	490,786	15,224,141
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OASIS C-2/ICD-10 Change (Crosswalk)	Appendix A OASISICD10-OASISc2 Change Table final 3-15-16 SXF (3).docx	07/05/2016
OASIS-C2 Manual	OASIS-C2 Guidance Manual 6-17-16.pdf	07/05/2016

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