Information Collection

Advance Beneficiary Notice and Supporting Regulations in 42 CFR 411.404, 411.406, and 411.408

IC 8163 under ICR 200404-0938-001 · OMB 0938-0566.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0566 can be found here:

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Information Collection (IC) Details

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IC Title:	Advance Beneficiary Notice and Supporting Regulations in 42 CFR 411.404, 411.406, and 411.408	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-131				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,084,932	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,171,480	936,050	20,235,430
Annual IC Time Burden (Hours)	1,764,290	78,004	1,686,286
Annual IC Cost Burden (Dollars)	0	0	0

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