Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data Collection)

IC 215972 under ICR 202107-0938-018 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Guidance Manual-7-2-2018 Final.pdf	Instruction
CMS-10545 OASIS-D Item Set Attachment-B-OASIS-D1_All Items.pdf	Form and Instruction
CMS-10545 OASIS-D Item Set Attachment-B-OASIS-D1_All Items.pdf	Form and Instruction
CMS-10545 - OASIS-D Guidance Manual-7-2-2018 Final.pdf OASIS-D Guidance Manual	IC Document
CMS-10545 - OASIS-D Guidance Manual-7-2-2018 Final.pdf OASIS-D Guidance Manual	IC Document
508_Attachment B itemized list of data elements.pdf CMS-10545 - Itemized List of Data Elements	IC Document
508_Attachment B 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 484.250 42 CFR 484.55 42 CFR 484.205 42 CFR 484.245 42 CFR 484.20

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	Attachment-B-OASIS-D1_All Items.pdf		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: 11,400

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	17,932,166	-229,776	18,161,942
Annual IC Time Burden (Hours)	9,893,376	-1,660,722	11,554,098
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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	508_Attachment B itemized list of data elements.pdf	07/29/2021

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