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Federal forms, ICRs, and supporting documents

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 202402-0938-010 · OMB 0938-1140.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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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)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 413.343 42 CFR 483.20 42 CFR 413.337 42 CFR 424.32

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 MDS 3.0 NP-PPS Item Set v1.19.1.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10387 Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual (Cover Only) Draft_MDS-3.0-RAI-Manual-v1.19.1_October_2024.pdf https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual Yes Yes Fillable Fileable
Form and Instruction CMS-10387 Nursing Home Part A PPS Discharge (NPE) Item Set MDS 3.0 NPE Item Set v1.19.1.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10387 Interim Payment Assessment (IPA) Item Set MDS 3.0 IPA Item Set v1.19.1.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10387 Swing Bed Discharge (SD) Item Set MDS 3.0 SD Item Set v1.19.1.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10387 Swing Bed PPS (SP) Item Set MDS 3.0 SP-PPS Item Set v1.19.1.pdf Yes Yes Fillable Fileable

Health Health Care Services

Long Term Care-Minimum Data Set'' (MDS), System No. 09-70-1517  72 FR 12801

15,471 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,469,183 0 97,190 0 0 3,371,993
Annual IC Time Burden (Hours) 2,861,351 0 -4,843 0 0 2,866,194
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Change Table MDS 3.0 Item Set Change History v1.19.1.pdf 02/27/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.