Information Collection

Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare

IC 8309 under ICR 200706-0938-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form CMS-R-193 SP Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare Form
Notice Instructions Important Message Spanish 06 19 07.doc Instruction
CMS-R-193 SP MENSAJE IMPORTANTE DE MEDICARE SOBRE SUS DERECHOS IM Form Spanish 6 19 07.doc Form
CMS-R-193 The Important Message From Medicare Revised Important Message from Medicare 05_2007a.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 405.1205 42 CFR 422.620

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-193 SP	MENSAJE IMPORTANTE DE MEDICARE SOBRE SUS DERECHOS	IM Form Spanish 6 19 07.doc	Yes	Yes	Paper Only
Instruction			Notice Instructions Important Message Spanish 06 19 07.doc	Yes	Yes	Paper Only
Form and Instruction	CMS-R-193	The Important Message From Medicare	Revised Important Message from Medicare 05_2007a.doc	Yes	Yes	Paper Only

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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	13,000,000	13,000,000
Annual IC Time Burden (Hours)	3,250,000	3,250,000
Annual IC Cost Burden (Dollars)	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.