Information Collection Request
Medicare Outpatient Observation Notice (MOON) (CMS-10611)
ICR 202212-0938-016 · OMB 0938-1308 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1308 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10611 Medicare Outpatient Observation Notice |
Form | Unchanged | Available |
 CMS-10611_Supporting Statement_.docx |
Supporting Statement A | Uploaded 2023-01-04 | Repair queued |
 2022Crosswalk for CMS-10611_SPANISH.xlsx |
Supplementary Document | Uploaded 2022-12-16 | Repair queued |
| (0938-1308) Nonsub Memo_CMS-10611.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-01-04 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 221292 |  Medicare Outpatient Observation Notice |
Form | Unchanged |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1308 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202212-0938-013 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 2023-01-05 |
| Requested Expiration Date | 1969-12-31 |