Information Collection

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)

IC 197759 under ICR 202304-0938-012 · OMB 0938-1140.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1140 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
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
CMS-10387 Nursing Home PPS (NP) Item Set Draft MDS3.0 NP Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Nursing Home PPS (NP) Item Set Draft MDS3.0 NP Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Long-Term Care Facility Resident Assessment Instrument ( Cover Page MDS RAI Manual v1.18.11.docx www.cms.gov/files/document/draftmds-30-rai-manual-v11811october2023.pdf-0	Form and Instruction
CMS-10387 Long-Term Care Facility Resident Assessment Instrument ( Cover Page MDS RAI Manual v1.18.11.docx www.cms.gov/files/document/draftmds-30-rai-manual-v11811october2023.pdf-0	Form and Instruction
CMS-10387 Nursing Home Part A PPS Discharge (NPE) Item Set Draft MDS3.0 NPE Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Nursing Home Part A PPS Discharge (NPE) Item Set Draft MDS3.0 NPE Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Interim Payment Assessment (IPA) Item Set Draft MDS3.0 IPA Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Interim Payment Assessment (IPA) Item Set Draft MDS3.0 IPA Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Swing Bed Discharge (SD) Item Set Draft MDS3.0 SD Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Swing Bed Discharge (SD) Item Set Draft MDS3.0 SD Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Swing Bed PPS (SP) Item Set Draft MDS3.0 SP Item Set v1.18.11 Oct2023.pdf	Form and Instruction
CMS-10387 Swing Bed PPS (SP) Item Set Draft MDS3.0 SP Item Set v1.18.11 Oct2023.pdf	Form and Instruction
Draft MDS3.0_Item Set Change History_v1.18.11 Oct2023.pdf Crosswalk	IC Document
Draft MDS3.0_Item Set Change History_v1.18.11 Oct2023.pdf Crosswalk	IC Document
Draft MDS3.0 NP Item Set v1.18.11 Oct2023+ new items highlighted.docx NP Item set v1.18.11 new items	IC Document
Draft MDS3.0 NP Item Set v1.18.11 Oct2023+ new items highlighted.docx NP Item set v1.18.11 new items	IC Document
Draft MDS3.0 NPE Item Set v1.18.11 Oct2023+ new items highlighted.docx NPE Item Set v1.18.11 new items	IC Document
Draft MDS3.0 NPE Item Set v1.18.11 Oct2023+ new items highlighted.docx NPE Item Set v1.18.11 new items	IC Document
Draft MDS3.0 IPA Item Set v1.18.11 Oct2023+ new items highlighted.docx IPA Item Set v1.18.11 new items	IC Document
Draft MDS3.0 IPA Item Set v1.18.11 Oct2023+ new items highlighted.docx IPA Item Set v1.18.11 new items	IC Document
Draft MDS3.0 SD Item Set v1.18.11 Oct2023 + new items highlighted.docx SD Item Set v1.18.11 new items	IC Document
Draft MDS3.0 SD Item Set v1.18.11 Oct2023 + new items highlighted.docx SD Item Set v1.18.11 new items	IC Document
Draft MDS3.0 SP Item Set v1.18.11 Oct2023 + new items higlighted.docx SP Item Set v1.18.11 new item	IC Document
Draft MDS3.0 SP Item Set v1.18.11 Oct2023 + new items higlighted.docx SP Item Set v1.18.11 new item	IC Document
MDS3.0_NP_PPS_v1.17.2+ removed items redlined.docx NP item set v1.18.11 removed items	IC Document
MDS3.0_NP_PPS_v1.17.2+ removed items redlined.docx NP item set v1.18.11 removed items	IC Document
MDS3.0_NPE_Part_A_PPS_Discharge_v1.17.2 + removed items redlined.docx NPE item set v1.18.11 removed items	IC Document
MDS3.0_NPE_Part_A_PPS_Discharge_v1.17.2 + removed items redlined.docx NPE item set v1.18.11 removed items	IC Document
MDS3.0_IPA_v1.17.2 + removed items redlined.docx IPA item set v1.18.11 removed items	IC Document
MDS3.0_IPA_v1.17.2 + removed items redlined.docx IPA item set v1.18.11 removed items	IC Document
MDS3.0_SD_Dschg_v1.17.2 + removed items redlined.docx SD item set v1.18.11 removed items	IC Document
MDS3.0_SD_Dschg_v1.17.2 + removed items redlined.docx SD item set v1.18.11 removed items	IC Document
MDS3.0_SP_PPS_v1.17.2 + removed items redlined.docx SP item set v1.18.11 removed items	IC Document
MDS3.0_SP_PPS_v1.17.2 + removed items redlined.docx SP item set v1.18.11 removed items	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 413.343 42 CFR 483.20 42 CFR 413.337 42 CFR 424.32

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-10387	Nursing Home PPS (NP) Item Set	Draft MDS3.0 NP Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10387	Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual (Cover Only)	Cover Page MDS RAI Manual v1.18.11.docx	https://www.cms.gov/files/document/draftmds-30-rai-manual-v11811october2023.pdf-0	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Nursing Home Part A PPS Discharge (NPE) Item Set	Draft MDS3.0 NPE Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Interim Payment Assessment (IPA) Item Set	Draft MDS3.0 IPA Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Swing Bed Discharge (SD) Item Set	Draft MDS3.0 SD Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Swing Bed PPS (SP) Item Set	Draft MDS3.0 SP Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,472

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	3,371,993	-1,533,049	4,905,042
Annual IC Time Burden (Hours)	2,866,194	-1,303,092	4,169,286
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	Draft MDS3.0_Item Set Change History_v1.18.11 Oct2023.pdf	04/19/2023
NP Item set v1.18.11 new items	Draft MDS3.0 NP Item Set v1.18.11 Oct2023+ new items highlighted.docx	04/19/2023
NPE Item Set v1.18.11 new items	Draft MDS3.0 NPE Item Set v1.18.11 Oct2023+ new items highlighted.docx	04/19/2023
IPA Item Set v1.18.11 new items	Draft MDS3.0 IPA Item Set v1.18.11 Oct2023+ new items highlighted.docx	04/19/2023
SD Item Set v1.18.11 new items	Draft MDS3.0 SD Item Set v1.18.11 Oct2023 + new items highlighted.docx	04/19/2023
SP Item Set v1.18.11 new item	Draft MDS3.0 SP Item Set v1.18.11 Oct2023 + new items higlighted.docx	04/19/2023
NP item set v1.18.11 removed items	MDS3.0_NP_PPS_v1.17.2+ removed items redlined.docx	04/19/2023
NPE item set v1.18.11 removed items	MDS3.0_NPE_Part_A_PPS_Discharge_v1.17.2 + removed items redlined.docx	04/19/2023
IPA item set v1.18.11 removed items	MDS3.0_IPA_v1.17.2 + removed items redlined.docx	04/19/2023
SD item set v1.18.11 removed items	MDS3.0_SD_Dschg_v1.17.2 + removed items redlined.docx	04/19/2023
SP item set v1.18.11 removed items	MDS3.0_SP_PPS_v1.17.2 + removed items redlined.docx	04/19/2023

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