Information Collection

Important Message From Medicare

IC 237581 under ICR 202212-0938-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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
CMS_10065_IMinstructions_2022_OSORA.pdf	Instruction
CMS_10065_IMinstructions_2022_OSORA.pdf	Instruction
CMS-100065/10066 Important Message from Medicare CMS-10655_IM_2022_v508_OSORA.pdf	Form and Instruction
CMS-100065/10066 Important Message from Medicare CMS-10655_IM_2022_v508_OSORA.pdf	Form and Instruction
CMS-10065/10066 Important Message from Medicare CMS10065_IM_Spanish_2022.docx	Form and Instruction
CMS-10065/10066 Important Message from Medicare CMS10065_IM_Spanish_2022.docx	Form and Instruction

IC Title:

Important Message From Medicare

Agency IC Tracking Number:

CM-CPC

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Instruction			CMS_10065_IMinstructions_2022_OSORA.pdf	No	Paper Only
Form and Instruction	CMS-100065/10066	Important Message from Medicare	CMS-10655_IM_2022_v508_OSORA.pdf	No	Paper Only
Form and Instruction	CMS-10065/10066	Important Message from Medicare	CMS10065_IM_Spanish_2022.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,312

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
	Requested	Previously Approved
Annual Number of Responses for this IC	14,042,374	14,042,374
Annual IC Time Burden (Hours)	2,340,396	2,340,396
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.