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⚠️ Notice: This information collection may be referencing outdated material.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 Important Message from Medicare 508_IM2013CMSR193v508.pdf Form and Instruction
CMS-R-193 Mensaje Importante De Medicare Sobre Sus Derechos 508_SpanishIM2013CMSR193v508.pdf 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	Important Message from Medicare	508_IM2013CMSR193v508.pdf		No	No	Paper Only
Form and Instruction	CMS-R-193	Mensaje Importante De Medicare Sobre Sus Derechos	508_SpanishIM2013CMSR193v508.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	19,840,000	160,000	19,680,000
Annual IC Time Burden (Hours)	2,976,000	24,000	2,952,000
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.