View Information Collection (IC)

View Information Collection (IC)

Long Term Care Data Set
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10409 LTCH Care Data Set Admissions LTCH CARE Data Set Version 4.00 - Admission.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LTCH Care Data Set Expired LTCH CARE Data Set Version 4.00 - Expired.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LTCH Care Data Set Planned Discharge LTCH CARE Data Set Version 4.00 - Planned Discharge.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10409 LTCH Care Data Set Unplanned Discharge LTCH CARE Data Set Version 4.00 - Unplanned Discharge.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

426 112
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 293,184 0 0 -112,086 0 405,270
Annual IC Time Burden (Hours) 165,884 0 0 -226,977 0 392,861
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix A: Master List Appendix A - Master List of LTCH CARE Data Set Version 4.00 Items.xlsx 06/28/2017
Appendix B: LTCH Version 4.0 Change Table Appendix B - Proposed LTCH CARE Data Set Version 4.00 Change Table - Effective April 1, 2018.pdf 06/28/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.