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 is listed under ICR 201702-0938-011.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
CMS R-10 Response to Public Comments.docx Supplementary Document
CMS-R-10 AdvancedDirectives FINAL 8-28-17.docxSupporting Statement A
CMS-R-10 Form 83 - Part II (Policies and Procedures) Information collection
CMS-R-10 Form 83 - Part II (Documenting Advanced Directive) Information collection
CMS-R-10 Form 83 - Part II (Developing Advanced Directive) Information collection
CMS-R-10 Form 83 - Part II (Annual Update) Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201702-0938-011 Extension without change of a currently approved collection 2017-02-27 Approved with change
201312-0938-008 Reinstatement with change of a previously approved collection 2013-12-09 Approved without change
200810-0938-019 Extension without change of a currently approved collection 2008-10-31 Approved with change
200508-0938-001 Extension without change of a currently approved collection 2005-08-05 Approved without change
200205-0938-007 Extension without change of a currently approved collection 2002-05-10 Approved without change
199903-0938-005 Extension without change of a currently approved collection 1999-03-15 Approved without change
199605-0938-009 Extension without change of a currently approved collection 1996-05-31 Approved without change
199304-0938-002 Revision of a currently approved collection 1993-04-19 Approved without change
199204-0938-001 New collection (Request for a new OMB Control Number) 1992-04-17 Approved without change

OMB Details

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

Federal Enterprise Architecture: Health - Health Care Services