Information Collection

Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare

IC 8309 under ICR 200704-0938-004 · OMB 0938-0692.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0692 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,000,000	500,000	12,500,000
Annual IC Time Burden (Hours)	3,250,000	3,041,667	208,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.