Information Collection Request
Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408 (CMS-R-131)
ICR 202211-0938-012 · OMB 0938-0566 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0566 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form |
Modified |
Supplementary Document | 2020-01-29 |
Supplementary Document | 2019-12-18 |
Supporting Statement A | 2020-01-29 |
Form CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408
Response to Public Comments_CMS-2019-0121(012220)_508.pdf
CMS-R-131 - Supporting Statement A_CLEAN(012220)_508.docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 8163 | Modified |
Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0566 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 201912-0938-015 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |