View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

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
Form CMS-R-131 Yes No Fillable Fileable
Form and Instruction CMS-R-131 Yes No Printable Only
Form CMS-R-131 Yes No Fillable Fileable
Form CMS-R-131 Yes No Fillable Fileable
Form CMS-R-131 Yes No Fillable Fileable
Form CMS-R-131 Yes No Fillable Fileable

Health Health Care Services

 

1,723,755 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 331,715,277 0 0 7,767,647 0 323,947,630
Annual IC Time Burden (Hours) 38,701,221 0 0 906,251 0 37,794,970
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Advance Beneficiary Notice Instruction - Track Change version 11/18/2025
Advance Beneficiary Notice Form - Track Change version 11/18/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.