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Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare
Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare
OMB: 0938-0692
IC ID: 8309
OMB.report
HHS/CMS
OMB 0938-0692
ICR 200704-0938-004
IC 8309
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0692 can be found here:
2016-07-20 - Extension without change of a currently approved collection
2013-05-22 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
CMS-R-193 Notice Instructions Important Message 3_ 20_07.doc
Instruction
Notice Instructions Important Message for OMB 05 16 07.doc
Instruction
Revised IM for OMB 05 16 07.doc
Other-Revised IM
Summary of changes made to the Important Message 05 16 07.doc
Other-Summary of Changes
Notice Instructions Important Message for OMB 05 16 07(5-21-07).doc
Instruction
CMS-R-193 AN IMPORTANT MESSAGE FROM MEDICARE
CMS-R-193 DRAFT Important Message from Medicare 3_20_07.doc
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 405.1205
42 CFR 422.620
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
Notice Instructions Important Message for OMB 05 16 07(5-21-07).doc
Yes
Yes
Paper Only
Other-Summary of Changes
Summary of changes made to the Important Message 05 16 07.doc
Yes
Yes
Paper Only
Instruction
Notice Instructions Important Message for OMB 05 16 07.doc
Yes
Yes
Paper Only
Other-Revised IM
Revised IM for OMB 05 16 07.doc
Yes
Yes
Paper Only
Form
CMS-R-193
AN IMPORTANT MESSAGE FROM MEDICARE
CMS-R-193 DRAFT Important Message from Medicare 3_20_07.doc
Yes
No
Paper Only
Instruction
CMS-R-193 Notice Instructions Important Message 3_ 20_07.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
6,000
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:
0 %
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
13,000,000
0
500,000
0
0
12,500,000
Annual IC Time Burden (Hours)
3,250,000
0
3,041,667
0
0
208,333
Annual IC Cost Burden (Dollars)
0
0
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.