Information Collection

Medicare and Medicaid OASIS Collection Requirements (Data Collection)

IC 215972 under ICR 202512-0938-012 · OMB 0938-1279.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10545 Medicare and Medicaid OASIS Collection Requirements (Data Collection)	Form and Instruction
Form CMS-10545 Attachment_B_OASIS-E2-All-Items-instrument - Final Medicare and Medicaid OASIS Collection Requirements (Data Collection)	Form and Instruction
CMS-10545 Attachment_B_OASIS-E2-All-Items-instrument - Final Attachment_B_OASIS-E2-All-Items-instrument - Final.pdf	Form and Instruction
CMS-10545 Attachment_B_OASIS-E2-All-Items-instrument - Final Attachment_B_OASIS-E2-All-Items-instrument - Final.pdf	Form and Instruction
Attachment_A_OASIS_E2_Change_Table 508.pdf Attachment_A_OASIS_E2_Change_Table 508	IC Document
Attachment_A_OASIS_E2_Change_Table 508.pdf Attachment_A_OASIS_E2_Change_Table 508	IC Document
Attachment C_ OASIS-E2 Itemized List of Data Elements 508.pdf Attachment C_ OASIS-E2 Itemized List of Data Elements 508	IC Document
Attachment C_ OASIS-E2 Itemized List of Data Elements 508.pdf Attachment C_ OASIS-E2 Itemized List of Data Elements 508	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 484.205 42 CFR 484.20 42 CFR 484.250 42 CFR 484.55 42 CFR 484.245

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-10545				Yes	Yes	Fillable Fileable

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: 83 FR 6591

Number of Respondents: 12,135

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	18,425,499	408,443	18,017,056
Annual IC Time Burden (Hours)	16,936,624	253,334	16,683,290
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment_A_OASIS_E2_Change_Table 508		07/07/2025
Attachment C_ OASIS-E2 Itemized List of Data Elements 508		07/07/2025

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

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