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⚠️ Notice: This information collection may be referencing outdated material.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-SP Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detailed Notice of Discharge (CMS-10066) Form
Detailed Notice Instructions Spanish 06 19 07.doc Instruction
CMS-10066-SP AVISO DETALLADO SOBRE DADO DE ALTA Detailed Notice Spanish 06 19 07.doc Form
CMS-10066 Detailed Notice of Discharge Revised Detailed Notice of Discharge - FINAL 05_2007.doc Form and Instruction

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: Modified

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-SP	AVISO DETALLADO SOBRE DADO DE ALTA	Detailed Notice Spanish 06 19 07.doc	Yes	Yes	Paper Only
Instruction			Detailed Notice Instructions Spanish 06 19 07.doc	Yes	Yes	Paper Only
Form and Instruction	CMS-10066	Detailed Notice of Discharge	Revised Detailed Notice of Discharge - FINAL 05_2007.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	Previously Approved
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.