Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detailed Notice of Discharge (CMS-10066)

Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detaile

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1019 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10066 Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detailed Notice of Discharge (CMS-10066) Form
CMS 10066 Notice Instructions Detailed Notice of Discharge March 2007.doc Instruction
Revised Detailed for OMB 05 16 07.doc Other-Revised Detail
Revised Detailed Notice Instructions for OMB 05 16 07.doc Other-Revised Notice Instructions
Summary of changes made to Detailed Notice 05 16 07.doc Other-Summary of Changes
CMS-10066 DETAILED NOTICE OF DISCHARGE CMS-10066 Revised DRAFT Detailed Notice of Discharge March 2007.doc Form

Information Collection (IC) Details

IC Title:	Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detailed Notice of Discharge (CMS-10066)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 405.1206 42 CFR 422.622

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10066	DETAILED NOTICE OF DISCHARGE	CMS-10066 Revised DRAFT Detailed Notice of Discharge March 2007.doc	Yes	Yes	Paper Only
Instruction			CMS 10066 Notice Instructions Detailed Notice of Discharge March 2007.doc	Yes	Yes	Paper Only
Other-Revised Notice Instructions			Revised Detailed Notice Instructions for OMB 05 16 07.doc	Yes	Yes	Paper Only
Other-Summary of Changes			Summary of changes made to Detailed Notice 05 16 07.doc	Yes	Yes	Paper Only
Other-Revised Detail			Revised Detailed for OMB 05 16 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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	130,000	130,000
Annual IC Time Burden (Hours)	130,000	130,000
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.