Information Collection Request
Medicare Outpatient Observation Notice (MOON) (CMS-10611)
ICR 202212-0938-016 · OMB 0938-1308 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1308 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form |
Unchanged |
Supporting Statement A | 2023-01-04 |
Supplementary Document | 2022-12-16 |
Justification for No Material/Nonsubstantive Change | 2023-01-04 |
Form CMS-10611 Medicare Outpatient Observation Notice
CMS-10611_Supporting Statement_.docx
2022Crosswalk for CMS-10611_SPANISH.xlsxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 221292 | Unchanged |
Medicare Outpatient Observation NoticeICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1308 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202212-0938-013 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 2023-01-05 |
| Requested Expiration Date | 1969-12-31 |