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

Hospital Wage Index Occupational Mix Survey (CMS-10079)

Documents and Forms

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
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

Information Collection (IC) Details

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

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10079	Wage Index Occupational Mix Survey Data	CY 2025 HOSPITAL FORM CMS- 10079 OM Survey.xlsx		Yes	Yes	Fillable Fileable
Other-Introduction			CY_2022_CMS-10079_Medicare_Wage_Index_Occupational_Mix_Survey.docx		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 %

	Requested	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

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.