View Information Collection (IC)

View Information Collection (IC)

IC Title:	Medicare and Medicaid OASIS Collection Requirements (Data collection)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-245	OASIS-C1	Revised OASIS-C 1. 09.27.13. 508.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: Home Health Agency (HHA) Outcome and Assessment Information Set (OASIS), HHS/CMS/CMSO (System # 09-70-0522)	FR Citation: 72 FR 63906

Number of Respondents: 12,014	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 %

	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	17,268,890	0	796,555	0	0	16,472,335
Annual IC Time Burden (Hours)	15,224,141	0	-1,251,867	0	0	16,476,008
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
OASIS Burden Calculations	OASIS Burden Calculations.09.30.13.docx	11/25/2013
OASIS-C to Draft OASIS C-1 - Items, Timepoints and Uses Crosswalk	Attachment A. OASIS C to C1 Items Timepoints and Uses.10-01-13.pdf	11/25/2013
Crosswalk	OASIS-C1 Revisions since 60 day PRA package filing. 10.01.2013.docx	11/25/2013

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