OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

(CMS-R-10) Advanced Directives (Medicare and Medicard)

OMB 0938-0610 · HHS/CMS.

OMB 0938-0610

Certain Medicare and Medicaid organizations are responsible for collecting and documenting in a prominent place in medical records whether an individual has executed an advanced directive. This document indicates the individual's preference if he/she is incapacitated.

The latest form for (CMS-R-10) Advanced Directives (Medicare and Medicard) expires 2020-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Supplementary Document
Supporting Statement A
All Historical Document Collections
Approved with change
 Extension without change of a currently approved collection 2017-02-27
Approved without change
 Reinstatement with change of a previously approved collection 2013-12-09
Approved with change
 Extension without change of a currently approved collection 2008-10-31
Approved without change
 Extension without change of a currently approved collection 2005-08-05
Approved without change
 Extension without change of a currently approved collection 2002-05-10
Approved without change
 Extension without change of a currently approved collection 1999-03-15
Approved without change
 Extension without change of a currently approved collection 1996-05-31
Approved without change
 Revision of a currently approved collection 1993-04-19
Approved without change
 New collection (Request for a new OMB Control Number) 1992-04-17
OMB Details

CMS-R-10 Form 83 - Part II (Annual Update)

Federal Enterprise Architecture: Health - Health Care Services