Hospital Notices: IM / DND (CMS-10065/10066)

ICR 202212-0938-014

OMB: 0938-1019

Federal Form Document

⚠️ Notice: This information collection may be outdated.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

2023-01-05 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
10065_2022_Justification.docx.docx Justification for No Material/Nonsubstantive Change	2022-12-16
10065_2022_Justification.docx.docx Justification for No Material/Nonsubstantive Change	2022-12-16
CMS-10065-10066_SupportingStatement_.docx Supporting Statement A	2022-08-25
CMS-10065-10066_SupportingStatement_.docx Supporting Statement A	2022-08-25
2022Crosswalk for CMS-10065-10066_SPANISH.xlsx Supplementary Document	2022-12-16
2022Crosswalk for CMS-10065-10066_SPANISH.xlsx Supplementary Document	2022-12-16

IC Document Collections

IC ID	Document Title	Status
237581	Important Message From Medicare Instruction	Modified
179807	Hospital Discharges Detailed Notice of Discharge Instruction	Modified

ICR Details

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