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Federal forms, ICRs, and supporting documents

Information Collection Request

"Important Message from Medicare" Title XVII S1866(a)(1)(M), 42 CFR SS466.78, 489.20, 489.34, 489.27, 411.404, 412.42, and 417.440, S422.620

ICR 200202-0938-007 · OMB 0938-0692 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
8307 "Important Message from Medicare" Title XVII S1866(a)(1)(M), 42 CFR SS466.78, 489.20, 489.34, 489.27, 411.404, 412.42, and 417.440, S422.620 Form Migrated
ICR Details
0938-0692 200202-0938-007
Historical Inactive 200105-0938-006
HHS/CMS
"Important Message from Medicare" Title XVII S1866(a)(1)(M), 42 CFR SS466.78, 489.20, 489.34, 489.27, 411.404, 412.42, and 417.440, S422.620
Reinstatement with change of a previously approved collection   No
Regular
Withdrawn 04/29/2002
Retrieve Notice of Action (NOA) 02/28/2002
Withdrawn by agency to allow for further consultation with the industry and response to public comments. OMB waives publication of the Federal Register notice for resubmission of this package and will complete its PRA review within 30 days of its receipt of the resubmission.
  Inventory as of this Action Requested Previously Approved
0 0 0
0 0 0
0 0 0
Hospitals participating in the Medicare program have agreed to distribute the "Important Message from Medicare" to beneficiaries during the course of their hospital stay and inform them of their impending discharge. Receiving this information will provide all Medicare beneficiaries with some ability to participate and/or initiate discussions concerning actions that may affect their Medicare coverage, payment, and appeal rights in response to hospital notification their care will no longer continue.
None
None
No
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/28/2002