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Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408
 
No Modified
 
Mandatory
 
42 CFR 411.404(b) and (c) 42 CFR 411.408(d)(2) and (f)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-R-131 30 NEW ABN PRA Instructions (2)tcec.doc Yes Yes Paper Only
Form CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN) CMS-R-131 New 07 ABN Draft post 60 (4).doc Yes No Paper Only

Health Health Care Services

 

1,270,614 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 40,302,506 0 0 19,131,026 0 21,171,480
Annual IC Time Burden (Hours) 4,701,959 0 0 2,937,669 0 1,764,290
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Summary of Changes CMS-R-131 30 NEW ABN summary of changes (3)tcec.doc 05/16/2007
Redline: Advance Beneficiary Notice of Noncoverage New 07 ABN Draft post 60 (4)redline.doc 05/16/2007
Redline: Instructions 30 NEW ABN PRA Instructions (2)tcecredline.doc 05/16/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.