Important Message From Medicare

Hospital Notices: IM / DND (CMS-10065/10066)

OMB: 0938-1019

IC ID: 237581

Documents and Forms
Document Name
Document Type
Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Important Message From Medicare CM-CPC
 
No Modified
 
Mandatory
 
42 CFR 422.620  42 CFR 405.1205    

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction IM Instructions_2025_Updtd_.docx No   Paper Only
Form and Instruction CMS-100065/10066 Important Message from Medicare IM_CMS-10065_2025Updtd_.docx No   Paper Only
Form and Instruction CMS-10065/10066 Important Message from Medicare CMS10065_IM_Spanish_2022.docx No   Paper Only

Health Health Care Services

 

5,995 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 25,300,000 0 0 11,257,626 0 14,042,374
Annual IC Time Burden (Hours) 4,216,667 0 0 1,876,271 0 2,340,396
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change - Important Message CMS-10065_IM_2025_REDLINED.pdf 12/16/2025
Track Change - Instructions Important Message IM Instructions_2025_redline_v1.pdf 12/16/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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