Information Collection Request

Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the Collection of Data Related to the Patient Driven Payment Model and the Skilled Nursing Facility QRP (CMS-10387)

ICR 202608-0938-002 · OMB 0938-1140 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10387 Swing Bed PPS (SP) Item Set Form and Instruction Modified Available
Form CMS-10387 Swing Bed Discharge (SD) Item Set Form and Instruction Modified Available
Form CMS-10387 Interim Payment Assessment (IPA) Item Set Form and Instruction Modified Available
Form CMS-10387 Nursing Home Part A PPS Discharge (NPE) Item Set Form and Instruction Modified Available
Form CMS-10387 Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual (Cover Only) Form and Instruction Modified Available
Form CMS-10387 Nursing Home PPS (NP) Item Set Form and Instruction Modified Available
CMS-10387 - SupportingStatement A - Final Rule - 1.docx Supporting Statement A Uploaded 2026-08-05 Available

ICR Details

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table that charts list comparision
  Requested Previously Approved
36 Months From Approved 11/30/2028
2,784,397 2,784,397
2,682,974 2,682,974
0 0





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table that charts list of burden
IC Title Form No. Form Name
Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD) CMS-10387, CMS-10387, CMS-10387, CMS-10387, CMS-10387, CMS-10387 ,   ,   ,   ,   ,  

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,784,397 2,784,397 0 0 0 0
Annual Time Burden (Hours) 2,682,974 2,682,974 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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