Cms-10106

0938-0930

Justification of Non-material Modification

CMS-10106: Medicare Authorization to Disclose Personal Health Information

We are submitting an 83-C change worksheet for the Spanish version of the form. The content is identical to the English version. This Spanish version of the form will be used by our Spanish speaking Medicare beneficiaries to authorize Medicare to disclose their protected health information to a third-party. There will be no additional changes to the burden. We feel that by offering CMS-10106 in the Spanish version, our Spanish speaking community will have their process simplified when requesting information while minimizing the response time for Medicare.