Information Collection

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

IC 8309 under ICR 200706-0938-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-R-193 SP Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare	Form
Notice Instructions Important Message Spanish 06 19 07.doc	Instruction
CMS-R-193 SP MENSAJE IMPORTANTE DE MEDICARE SOBRE SUS DERECHOS IM Form Spanish 6 19 07.doc	Form
CMS-R-193 The Important Message From Medicare Revised Important Message from Medicare 05_2007a.doc	Form and Instruction

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
Form	CMS-R-193 SP	MENSAJE IMPORTANTE DE MEDICARE SOBRE SUS DERECHOS	IM Form Spanish 6 19 07.doc	Yes	Yes	Paper Only
Instruction			Notice Instructions Important Message Spanish 06 19 07.doc	Yes	Yes	Paper Only
Form and Instruction	CMS-R-193	The Important Message From Medicare	Revised Important Message from Medicare 05_2007a.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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	13,000,000	13,000,000
Annual IC Time Burden (Hours)	3,250,000	3,250,000
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.