Information Collection

MS-DRG classification change requests

IC 248700 under ICR 202509-0938-007 · OMB 0938-1431.

Documents and Forms

Document Name Document Type
Form CMS-10775 MS-DRG classification change requests Form and Instruction
Form CMS-10775 MEARIS Login ScreenShots MS-DRG classification change requests Form and Instruction
Form CMS-10775 New and Revised Medicare Severity Diagnosis Related Groups (MS-DRG) Request MS-DRG classification change requests Form and Instruction
CMS-10775 MEARIS Login ScreenShots MEARIS Login ScreenShots.docx Form and Instruction
CMS-10775 MEARIS Login ScreenShots MEARIS Login ScreenShots.docx Form and Instruction
CMS-10775 New and Revised Medicare Severity Diagnosis Related Grou New and Revised Medicare Severity Diagnosis Related Groups (MS-DRG) Request.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MS-DRG classification change requests	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 412.60

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10775	MEARIS Login ScreenShots	MEARIS Login ScreenShots.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10775	New and Revised Medicare Severity Diagnosis Related Groups (MS-DRG) Request	New and Revised Medicare Severity Diagnosis Related Groups (MS-DRG) Request.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	48,000	48,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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