Information Collection

Hospital Discharges Detailed Notice of Discharge

IC 179807 under ICR 202512-0938-011 · OMB 0938-1019.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10065/10066 Detailed Notice of Discharge Hospital Discharges Detailed Notice of Discharge	Form and Instruction
Form CMS-10065/10066 Detailed Notice of Discharge Hospital Discharges Detailed Notice of Discharge	Form and Instruction
DND Instructions_2025.docx	Instruction
DND Instructions_2025.docx	Instruction
CMS-10065/10066 Detailed Notice of Discharge DND_CMS-10066_2025Updtd_.docx	Form and Instruction
CMS-10065/10066 Detailed Notice of Discharge DND_CMS-10066_2025Updtd_.docx	Form and Instruction
CMS-10065/10066 Detailed Notice of Discharge CMS10066_DND_Spanish_2022.docx	Form and Instruction
CMS-10065/10066 Detailed Notice of Discharge CMS10066_DND_Spanish_2022.docx	Form and Instruction
CMS-10066_DND_2025_REDLINED.pdf Track Change - Detailed Notice of Discharge	IC Document
CMS-10066_DND_2025_REDLINED.pdf Track Change - Detailed Notice of Discharge	IC Document
DND Instructions2025_REDLINE v3.pdf Track Change - Instruction Detailed Notice of Discharge	IC Document
DND Instructions2025_REDLINE v3.pdf Track Change - Instruction Detailed Notice of Discharge	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.622 42 CFR 405.1206

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Instruction		No	Paper Only
Form and Instruction	CMS-10065/10066	No	Paper Only
Form and Instruction	CMS-10065/10066	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,995

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	97,156	52,444	44,712
Annual IC Time Burden (Hours)	97,156	52,444	44,712
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Track Change - Detailed Notice of Discharge		12/16/2025
Track Change - Instruction Detailed Notice of Discharge		12/16/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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