Information Collection

Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detailed Notice of Discharge (CMS-10066)

IC 179807 under ICR 201305-0938-015 · OMB 0938-1019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1019 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.