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Federal forms, ICRs, and supporting documents

Information Collection

Hospital Discharges Detailed Notice of Discharge

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

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

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction DND Instructions_2025.docx No   Paper Only
Form and Instruction CMS-10065/10066 Detailed Notice of Discharge DND_CMS-10066_2025Updtd_.docx 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

 

5,995 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Approved 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 97,156 0 0 52,444 0 44,712
Annual IC Time Burden (Hours) 97,156 0 0 52,444 0 44,712
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change - Detailed Notice of Discharge CMS-10066_DND_2025_REDLINED.pdf 12/16/2025
Track Change - Instruction Detailed Notice of Discharge DND Instructions2025_REDLINE v3.pdf 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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