Information Collection Request
Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408 (CMS-R-131)
ICR 202211-0938-012 · OMB 0938-0566 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0566 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408 |
Form | Modified | Repair queued |
 Response to Public Comments_CMS-2019-0121(012220)_508.pdf |
Supplementary Document | Uploaded 2020-01-29 | Repair queued |
| Response to Public Comments_CMS-2019-0121(112919)_508.pdf |
Supplementary Document | Uploaded 2019-12-18 | Missing upstream |
 CMS-R-131 - Supporting Statement A_CLEAN(012220)_508.docx |
Supporting Statement A | Uploaded 2020-01-29 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8163 |  Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408 |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0566 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 201912-0938-015 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |