OMB control number

Hospital Notices: IM / DND (CMS-10065/10066)

OMB 0938-1019 · HHS/CMS.

OMB 0938-1019

For all Medicare beneficiaries, hospitals must deliver valid, written notice of a beneficiary's rights as a hospital inpatient, including discharge appeal rights. The hospital must use a standardized notice, as specified by CMS. This is satisfied by IM delivery. When a QIO notifies a hospital that a beneficiary has requested an expedited discharge, the hospital must deliver a detailed notice to the beneficiary as soon as possible but no later than noon of the day after the QIO's notification. This is satisfied by DND delivery.

The latest form for Hospital Notices: IM / DND (CMS-10065/10066) expires 2029-03-31 and is listed under ICR 202512-0938-011.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10065/10066 Important Message from Medicare	Form and Instruction
Form CMS-100065/10066 Important Message from Medicare	Form and Instruction
Form CMS-10065/10066 Detailed Notice of Discharge	Form and Instruction
Form CMS-10065/10066 Detailed Notice of Discharge	Form and Instruction
CMS-10065.10066_Supporting Statement_A_.docx	Supporting Statement A
CMS-10065.10066_Supporting Statement_A_.docx	Supporting Statement A
CMS-2025-0931 CMS response to public comments.docx	Supplementary Document
CMS-2025-0931 CMS response to public comments.docx	Supplementary Document
CMS-2025-0931-DRAFT-0002 (1).html.pdf	Public Comments
Crosswalk IM CMS-10065v508.pdf	Supplementary Document
Crosswalk IM CMS-10065v508.pdf	Supplementary Document
Important Message From Medicare	Form and Instruction
Important Message From Medicare	Form and Instruction
Important Message From Medicare	Instruction
Hospital Discharges Detailed Notice of Discharge	Form and Instruction
Hospital Discharges Detailed Notice of Discharge	Form and Instruction
Hospital Discharges Detailed Notice of Discharge	Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202512-0938-011	Extension without change of a currently approved collection	2025-12-16	Approved without change
202212-0938-017	No material or nonsubstantive change to a currently approved collection	2023-01-05	Approved without change
202212-0938-014	No material or nonsubstantive change to a currently approved collection	2022-12-19	Improperly submitted and continue
202208-0938-019	Extension without change of a currently approved collection	2022-08-26	Approved without change
201912-0938-004	No material or nonsubstantive change to a currently approved collection	2019-12-04	Approved without change
201908-0938-010	Revision of a currently approved collection	2019-09-04	Approved without change
201607-0938-010	Extension without change of a currently approved collection	2016-07-20	Approved without change
201305-0938-015	Extension without change of a currently approved collection	2013-05-22	Approved without change
201005-0938-006	Extension without change of a currently approved collection	2010-05-13	Approved without change
200706-0938-008	No material or nonsubstantive change to a currently approved collection	2007-06-28	Approved without change
200704-0938-010	New collection (Request for a new OMB Control Number)	2007-04-25	Approved with change

OMB Details

Hospital Discharges Detailed Notice of Discharge

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10065/10066	Detailed Notice of Discharge	Paper Only	Form and instruction
Form CMS-10065/10066	Detailed Notice of Discharge	Paper Only	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.