View Information Collection (IC)
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View Information Collection (IC)
View Information Collection (IC)
IC Title:
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)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
42 CFR 413.343
42 CFR 483.20
42 CFR 413.337
42 CFR 424.32
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10387
Nursing Home PPS (NP) Item Set
MDS 3.0 NP-PPS Item Set v1.19.1.pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10387
Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual (Cover Only)
Draft_MDS-3.0-RAI-Manual-v1.19.1_October_2024.pdf
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10387
Nursing Home Part A PPS Discharge (NPE) Item Set
MDS 3.0 NPE Item Set v1.19.1.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10387
Interim Payment Assessment (IPA) Item Set
MDS 3.0 IPA Item Set v1.19.1.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10387
Swing Bed Discharge (SD) Item Set
MDS 3.0 SD Item Set v1.19.1.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10387
Swing Bed PPS (SP) Item Set
MDS 3.0 SP-PPS Item Set v1.19.1.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Long Term Care-Minimum Data Set'' (MDS), System No. 09-70-1517
FR Citation:
72 FR 12801
Number of Respondents:
15,471
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Approved
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
3,469,183
0
97,190
0
0
3,371,993
Annual IC Time Burden (Hours)
2,861,351
0
-4,843
0
0
2,866,194
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Change Table
MDS 3.0 Item Set Change History v1.19.1.pdf
02/27/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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