Information Collection

Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64

IC 8747 under ICR 202511-0938-008 · OMB 0938-0907.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10079 Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64	Form and Instruction
Form CMS-10079 Wage Index Occupational Mix Survey Data Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64	Form and Instruction
CY_2022_CMS-10079_Medicare_Wage_Index_Occupational_Mix_Survey.docx	Other-Introduction
CY_2022_CMS-10079_Medicare_Wage_Index_Occupational_Mix_Survey.docx	Other-Introduction
CMS-10079 Wage Index Occupational Mix Survey Data CY 2025 HOSPITAL FORM CMS- 10079 OM Survey.xlsx	Form and Instruction
CMS-10079 Wage Index Occupational Mix Survey Data CY 2025 HOSPITAL FORM CMS- 10079 OM Survey.xlsx	Form and Instruction

IC Title:

Agency IC Tracking Number:

CM-FFS

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 412.64

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-10079				Yes	Yes	Fillable Fileable
Other-Introduction					Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,100

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	3,100	-100	3,200
Annual IC Time Burden (Hours)	1,488,000	-48,000	1,536,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].