Information Collection

"Important Message from Medicare" Title XVII Section 1866(a)(1) (M), 42 CFR Section 466.78, 489.20, and 489.27

IC 8308 under ICR 200210-0938-003 · OMB 0938-0692.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0692 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	"Important Message from Medicare" Title XVII Section 1866(a)(1) (M), 42 CFR Section 466.78, 489.20, and 489.27	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-193				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,031	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,800,000	11,800,000
Annual IC Time Burden (Hours)	196,666	196,666
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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