Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data Collection)

IC 215972 under ICR 202406-0938-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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-E Item Set Attachment B OASIS-E1 All Items 03-22-2024.pdf Form and Instruction
CMS-10545 OASIS-E Item Set Attachment B OASIS-E1 All Items CLEAN_120624.docx Form and Instruction
Attachment C_ OASIS-E1 Itemized List of Data Elements.pdf CMS-10545 - Itemized List of Data Elements IC Document
Attachment C_ OASIS-E1 Itemized List of Data Elements.pdf CMS-10545 - Itemized List of Data Elements IC Document
Attachment_A_OASIS_E1 Change Table.pdf Change table IC Document
Attachment_A_OASIS_E1 Change Table.pdf Change table IC Document

Information Collection (IC) Details

View Information Collection (IC)

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 484.250 42 CFR 484.55 42 CFR 484.20 42 CFR 484.205 42 CFR 484.245

Information Collection 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 OASIS-E1 All Items CLEAN_120624.docx		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: 11,866	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	18,017,056	-13,710	18,030,766
Annual IC Time Burden (Hours)	16,683,290	3,966,443	12,716,847
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10545 - Itemized List of Data Elements	Attachment C_ OASIS-E1 Itemized List of Data Elements.pdf	06/17/2024
Change table	Attachment_A_OASIS_E1 Change Table.pdf	06/17/2024

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