Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data Collection)

IC 215972 under ICR 202205-0938-016 · 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⚠️ Notice: This information collection may be referencing outdated material.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
OASIS-E_Merge_Draft_Guidance manual 508.pdf	Instruction
OASIS-E_Merge_Draft_Guidance manual 508.pdf	Instruction
CMS-10545 OASIS-D Item Set Attachment B_508_OASIS_E_AllItems.pdf	Form and Instruction
CMS-10545 OASIS-D Item Set Attachment B_508_OASIS_E_AllItems.pdf	Form and Instruction
Attachment C_ OASIS-E Itemized List of Data Elements_V2-12-16-2021_3.31.22 (2)VC 508.pdf CMS-10545 - Itemized List of Data Elements	IC Document
Attachment C_ OASIS-E Itemized List of Data Elements_V2-12-16-2021_3.31.22 (2)VC 508.pdf CMS-10545 - Itemized List of Data Elements	IC Document
Crosswalk - changes since 60 day FR notice 4-27-22.docx Crosswalk	IC Document
Crosswalk - changes since 60 day FR notice 4-27-22.docx Crosswalk	IC Document
Attachment A_OASIS E change table_V4-01-27-2022.pdf Change table	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	Attachment B_508_OASIS_E_AllItems.pdf		Yes	Yes	Fillable Fileable
Instruction			OASIS-E_Merge_Draft_Guidance manual 508.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: 11,354

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	18,030,766	98,600	17,932,166
Annual IC Time Burden (Hours)	12,716,847	2,823,471	9,893,376
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10545 - Itemized List of Data Elements	Attachment C_ OASIS-E Itemized List of Data Elements_V2-12-16-2021_3.31.22 (2)VC 508.pdf	05/19/2022
Crosswalk	Crosswalk - changes since 60 day FR notice 4-27-22.docx	05/19/2022
Change table	Attachment A_OASIS E change table_V4-01-27-2022.pdf	05/20/2022

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