Information Collection

Collection Of The Unique Identification Physician Number (upin) On The Health Insurance And Sections 4700 And 4708 Medigap "medicare"

IC 112479 under ICR 199005-0938-005 · OMB 0938-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0008 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	COLLECTION OF THE UNIQUE IDENTIFICATION PHYSICIAN NUMBER (UPIN) ON THE HEALTH INSURANCE AND SECTIONS 4700 AND 4708 MEDIGAP "MEDICARE"	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1490S				No	No
Form	HCFA-1500				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 308,413	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	308,413	12,946	295,466	1
Annual IC Time Burden (Hours)	80,117,280	3,362,985	76,754,294	1
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

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