Information Collection

Uniform Billing Form For The State Of New York, Fr. Ubf-1, "medicare"

IC 113215 under ICR 198112-0938-023 · OMB 0938-0240.

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Information Collection (IC) Details

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IC Title:	UNIFORM BILLING FORM FOR THE STATE OF NEW YORK, FR. UBF-1, "MEDICARE"	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 310	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,108,800	1,108,800
Annual IC Time Burden (Hours)	200,000	200,000
Annual IC Cost Burden (Dollars)	0	0

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