Information Collection

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

IC 179807 under ICR 200704-0938-010 · OMB 0938-1019.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.