Information Collection

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)

IC 197759 under ICR 201809-0938-009 · OMB 0938-1140.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1140 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10387 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) Form and Instruction
CMS-10387 Nursing Home PPS (NP) Item Set MDS3 0_NP_PPS_v1 11 1 (1).pdf Form and Instruction
CMS-10387 Nursing Home OMRA-Start of Therapy and Discharge (NSD) I MDS3 0_NSD_OMRA-SOT-Dschg_v1 11 1.pdf Form and Instruction
CMS-10387 Nursing Home and Swing Bed OMRA-Start of Therapy (NS/SS) MDS3 0_NS_SS_OMRA-SOT_v1 11 1.pdf Form and Instruction
CMS-10387 Nursing Home OMRA-Discharge (NOD) Item Set MDS3 0_NOD_OMRA-Other-Dschg_v1 11 1.pdf Form and Instruction
CMS-10387 Nursing Home and Swing Bed OMRA (NO/SO) Item Set MDS3 0_NO_SO_OMRA-Other_v1 11 1.pdf Form and Instruction
CMS-10387 Long-Term Care Facility Resident Assessment Instrument U MDS PRA cover page_Exp. TBD.pdf downloads.cms.gov/files/MDS-30-RAI-Manual-v115-October-2017.pdf Form and Instruction

Information Collection (IC) Details

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 483.20 42 CFR 424.32 42 CFR 413.337 42 CFR 413.343

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 OMRA-Start of Therapy and Discharge (NSD) Item Set	MDS3 0_NSD_OMRA-SOT-Dschg_v1 11 1.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10387	Nursing Home and Swing Bed OMRA-Start of Therapy (NS/SS) Item Set	MDS3 0_NS_SS_OMRA-SOT_v1 11 1.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10387	Nursing Home OMRA-Discharge (NOD) Item Set	MDS3 0_NOD_OMRA-Other-Dschg_v1 11 1.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10387	Nursing Home and Swing Bed OMRA (NO/SO) Item Set	MDS3 0_NO_SO_OMRA-Other_v1 11 1.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10387	Long-Term Care Facility Resident Assessment Instrument User's Manual (Cover Only)	MDS PRA cover page_Exp. TBD.pdf	https://downloads.cms.gov/files/MDS-30-RAI-Manual-v115-October-2017.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Nursing Home PPS (NP) Item Set	MDS3 0_NP_PPS_v1 11 1 (1).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,471	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 Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,905,042	-2,029,606	371,304	6,563,344
Annual IC Time Burden (Hours)	4,169,286	-1,727,207	315,608	5,580,885
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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