Information Collection

Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare (CMS-10065/10066)

IC 237581 under ICR 201912-0938-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
IM_draft_instructions_v508.pdf	Instruction
IM_draft_instructions_Spanishv508.docx	Instruction
CMS-100065/10066 Important Message from Medicare IM_draft_v508.pdf	Form and Instruction
CMS-100065/10066 Important Message from Medicare (Spanish) IM_draft_Spanishv508.docx	Form and Instruction

IC Title:

Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare (CMS-10065/10066)

Agency IC Tracking Number:

CM-CPC

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.620Â 42 CFR 405.1205Â Â Â Â

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Instruction			IM_draft_instructions_v508.pdf	No	Paper Only
Form and Instruction	CMS-100065/10066	Important Message from Medicare	IM_draft_v508.pdf	No	Paper Only
Instruction			IM_draft_instructions_Spanishv508.docx	No	Paper Only
Form and Instruction	CMS-100065/10066	Important Message from Medicare (Spanish)	IM_draft_Spanishv508.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,140

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	Previously Approved
Annual Number of Responses for this IC	17,702,500	17,702,500
Annual IC Time Burden (Hours)	2,950,417	2,950,417
Annual IC Cost Burden (Dollars)	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.