Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare (CMS-R-193)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0692 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-R-193 Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare (CMS-R-193) Form and Instruction
CMS-R-193 An Important Message From Medicare About Your Rights im508final.doc Form and Instruction
CMS-R-193-SP Mensaje Importante De Medicare Sobre Sus Derechos IM Spanish final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare (CMS-R-193)	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-193	An Important Message From Medicare About Your Rights	im508final.doc		No	No	Paper Only
Form and Instruction	CMS-R-193-SP	Mensaje Importante De Medicare Sobre Sus Derechos	IM Spanish final.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,163	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	Previously Approved
Annual Number of Responses for this IC	19,680,000	6,680,000	13,000,000
Annual IC Time Burden (Hours)	2,952,000	-298,000	3,250,000
Annual IC Cost Burden (Dollars)	0	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.