172916100

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CROSSWALK DOCUMENT FOR CHANGES TO CMS-1696
(Appointment of Representative (AOR))
SUBMITTED FOR COLLECTION


SUMMARY OF CHANGES TO CMS-1696: In conjunction with statutory changes to the appeals process under BIPA and MMA (Benefits Improvement and Protections Act of 2000, and the Medicare Modernization Act of 2003, respectively), the requirements for appointing representatives for claims and appeals processed under 42 CFR Part 405 Subpart I were codified into regulation at 42 CFR 405.910. In summary, section 405.910 states an individual or entity may appoint a representative to act on their behalf in exercising their rights relative to an initial claim determination or an appeal. The appointment of representation must be in writing and must include all the required elements specified in 405.910(c). The burden associated with this requirement is the time and effort of the individual or entity to prepare an appointment of representation containing all the required information of this section. To reduce some of the burden associated with this requirement, we developed a standardized form that the individual/entity may opt (but is not required) to use. The English version of the AOR was last approved by OMB on August 12, 2026 with non-substantive changes; however, with this submission, the Spanish version of the form needs to be replaced with an updated Spanish version to include the non-substantive changes that were implemented to the form. There are no changes that will affect existing AOR users.

The following non-substantive changes have been made to the form:

    • Updated the existing Spanish version to implement the updated non-substantive changes that were approved by OMB on August 12, 2026 to the English version.

The AOR is an existing collection and is in use. It is our expectation that the non- substantive changes to the form will have little effect on burden for all users.