Information Collection

Uniform Billing Form

IC 112941 under ICR 198206-0938-001 · OMB 0938-0140.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0140 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	UNIFORM BILLING FORM	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
Form	HCFA-1480				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 381	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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	2,414,000	510,918	1,903,082
Annual IC Time Burden (Hours)	704,000	149,000	555,000
Annual IC Cost Burden (Dollars)	0	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.