MS-DRG classification change requests

Medicare Severity Diagnosis Related Groups Reclassification Request (MS-DRGs) (CMS-10775)

Documents and Forms

Document Name Document Type
Form CMS-10775 MS-DRG classification change requests Form and Instruction
CMS-10775 MEARIS Login ScreenShots MEARIS Login ScreenShots.docx Form and Instruction

Information Collection (IC) Details

IC Title:	MS-DRG classification change requests	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 412.60

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10775				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10775				No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	48,000	48,000
Annual IC Cost Burden (Dollars)	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.

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