Information Collection Request

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

ICR 202212-0938-017 · OMB 0938-1019 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1019 can be found here:

Forms and Documents

Document Name	Status
CMS-10065-10066_SupportingStatement_.docx Supporting Statement A	2023-01-04
(0938-1019) Nonsub Memo_CMS-10065 & 10066.docx Justification for No Material/Nonsubstantive Change	2023-01-04
2022Crosswalk for CMS-10065-10066_SPANISH.xlsx Supplementary Document	2022-12-16

IC Document Collections

IC ID	Document Title	Status
237581	Important Message From Medicare Instruction	Unchanged
179807	Hospital Discharges Detailed Notice of Discharge Instruction	Unchanged

ICR Details

Status	Active
Agency/Subagency	HHS/CMS
OMB Control No	0938-1019
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202212-0938-014
Agency Tracking No	CM-CPC
Date Submitted to OIRA	2023-01-05
Requested Expiration Date	1969-12-31