Information Collection Request
Hospital Notices: IM / DND (CMS-10065/10066)
ICR 202212-0938-017 · OMB 0938-1019 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1019 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 CMS-10065-10066_SupportingStatement_.docx |
Supporting Statement A | Uploaded 2023-01-04 | Available |
| (0938-1019) Nonsub Memo_CMS-10065 & 10066.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-01-04 | Available |
 2022Crosswalk for CMS-10065-10066_SPANISH.xlsx |
Supplementary Document | Uploaded 2022-12-16 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 237581 |  Important Message From Medicare |
Instruction | Unchanged | |
| 179807 | Hospital Discharges Detailed Notice of Discharge |
Instruction | Unchanged |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1019 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202212-0938-014 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 2023-01-05 |
| Requested Expiration Date | 1969-12-31 |