Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data Collection)

IC 215972 under ICR 202301-0938-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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-E Item Set Attachment B_508_OASIS_E_AllItems.pdf	Form and Instruction
CMS-10545 OASIS-E 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
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-E 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	Previously Approved
Annual Number of Responses for this IC	18,030,766	18,030,766
Annual IC Time Burden (Hours)	12,716,847	12,716,847
Annual IC Cost Burden (Dollars)	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.