Information Collection Request
Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the Collection of Data Related to the Patient Driven Payment Model and the Skilled Nursing Facility QRP (CMS-10387)
ICR 202304-0938-012 · OMB 0938-1140 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1140 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10387 Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD) |
Form and Instruction | Modified | Repair queued |
 PRA Disclosure Statement_v1.18.11.docx |
Supplementary Document | Uploaded 2023-04-19 | Repair queued |
| CMS-10387-MDS-Supporting-Statement-A_v11_clean 4-18-23.docx |
Supporting Statement A | Uploaded 2023-04-19 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 197759 |  Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1140 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202206-0938-012 |
| Agency Tracking No | CCSQ |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |