Medicare and Medicaid OASIS Collection Requirements (Data Collection)

Outcome and Assessment Information Set (OASIS-D) (CMS-10545)

⚠️ Notice: This information collection may be referencing outdated material.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-D Guidance Manual-7-2-2018 Final.pdf Instruction
CMS-10545 OASIS-D Item Set CMS-10545 - Attachment B OASIS 2019 rev2.docx Form and Instruction
CMS-10545 - Attachment A OASIS D Crosswalk compared to OASIS C2.docx OASIS D Crosswalk compared to OASIS C2 IC Document
CMS-10545 - OASIS-D Guidance Manual-7-2-2018 Final.pdf OASIS-D Guidance Manual IC Document
Attachment C itemized list of data elements.pdf CMS-10545 - Itemized List of Data Elements IC Document

Information Collection (IC) Details

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 484.20 42 CFR 484.250 42 CFR 484.55 42 CFR 484.205 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-D Item Set	CMS-10545 - Attachment B OASIS 2019 rev2.docx		Yes	Yes	Fillable Fileable
Instruction			CMS-10545 - OASIS-D Guidance Manual-7-2-2018 Final.pdf		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: 12,149	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	18,161,942	261,942	17,900,000
Annual IC Time Burden (Hours)	11,554,098	-4,160,829	15,714,927
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
OASIS D Crosswalk compared to OASIS C2	CMS-10545 - Attachment A OASIS D Crosswalk compared to OASIS C2.docx	11/21/2018
OASIS-D Guidance Manual	CMS-10545 - OASIS-D Guidance Manual-7-2-2018 Final.pdf	08/21/2018
CMS-10545 - Itemized List of Data Elements	Attachment C itemized list of data elements.pdf	08/21/2018

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