View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detailed Notice of Discharge (CMS-10066)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 405.1206 42 CFR 422.622

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10066-SP	AVISO DETALLADO SOBRE DADO DE ALTA	Detailed Notice Spanish 06 19 07.doc		Yes	Yes	Paper Only
Instruction			Detailed Notice Instructions Spanish 06 19 07.doc		Yes	Yes	Paper Only
Form and Instruction	CMS-10066	Detailed Notice of Discharge	Revised Detailed Notice of Discharge - FINAL 05_2007.doc		Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	130,000	0	0	0	0	130,000
Annual IC Time Burden (Hours)	130,000	0	0	0	0	130,000
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.