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

Hospital Notices: Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (CMS-10065/10066)

⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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 422.620 42 CFR 405.1205

Information Collection 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 %

	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

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.