Hospital Discharges Detailed Notice of Discharge

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

OMB: 0938-1019

IC ID: 179807

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Hospital Discharges Detailed Notice of Discharge
 
No Modified
 
Mandatory
 
42 CFR 405.1206 42 CFR 422.622

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS_10066_DNDinstructions_2022_OSORA.pdf No   Paper Only
Form and Instruction CMS-10065/10066 Detailed Notice of Discharge CMS_10066_DND_2022_OSORA.pdf No   Paper Only
Form and Instruction CMS-10065/10066 Detailed Notice of Discharge CMS10066_DND_Spanish_2022.docx No   Paper Only

Health Health Care Services

 

4,312 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 44,712 0 0 0 0 44,712
Annual IC Time Burden (Hours) 44,712 0 0 0 0 44,712
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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