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Federal forms, ICRs, and supporting documents

Information Collection

Uniform Bill Questionnaire

IC 112933 under ICR 198006-0938-001 · OMB 0938-0117.

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Information Collection (IC) Details

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UNIFORM BILL QUESTIONNAIRE
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-79 No No
Form HCFA-79T No No


    

500 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved 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 500 0 0 500 0 0
Annual IC Time Burden (Hours) 750 0 0 750 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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