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⚠️ Notice: This information collection may be referencing outdated material.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 Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detailed Notice of Discharge (CMS-10066) Form and Instruction
CMS-10066 Detailed Notice of Discharge 508_DetailedNoticeofDischarge2013v508.pdf Form and Instruction
CMS-10066 Detailed Notice of Discharge (Spanish Language Version) SpanishDetailedNoticeofDischarge2013v508.pdf 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 422.622 42 CFR 405.1206

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10066	Detailed Notice of Discharge	508_DetailedNoticeofDischarge2013v508.pdf		No	No	Paper Only
Form and Instruction	CMS-10066	Detailed Notice of Discharge (Spanish Language Version)	SpanishDetailedNoticeofDischarge2013v508.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,169	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,852	-366	13,218
Annual IC Time Burden (Hours)	12,852	-366	13,218
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.