Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data Collection)

IC 215972 under ICR 201808-0938-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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-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

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:

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.