Long Term Care Data Set

Long Term Care Hospital (LTCH) Quality Reporting Program (CMS-10409)

OMB: 0938-1163

IC ID: 201171

Information Collection (IC) Details

View Information Collection (IC)

Long Term Care Data Set
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10409 LCDS version 5.2 Admission LTCH-CARE-Data-Set-Version-5.2-Admission.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LCDS version 5.2 Expired LTCH-CARE-Data-Set-Version-5.2-Expired.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LCDS version 5.2 Planned Discharge LTCH-CARE-Data-Set-Version-5.2-Planned-Discharge.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LCDS version 5.2 Unplanned Discharge LTCH-CARE-Data-Set-Version-5.2-Unplanned-Discharge.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 Social Determinants of Health Section R_SDOH Complete+FINAL.docx Yes Yes Fillable Fileable

Health Health Care Services

 

330 89
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 226,940 0 -70,113 0 0 297,053
Annual IC Time Burden (Hours) 187,735 0 -23,646 0 0 211,381
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Crosswalk-LCDS-5.1-to-5.2.pdf 08/30/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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