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Uniform Hospital Bill (hcfa-1450) And Related Electronic Media Claim Format - Medicaid System Requirements

IC 113779 under ICR 199104-0938-004 · OMB 0938-0458.

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UNIFORM HOSPITAL BILL (HCFA-1450) AND RELATED ELECTRONIC MEDIA CLAIM FORMAT - MEDICAID SYSTEM REQUIREMENTS
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-R-59 No No


    

1 0
   
State, Local, and Tribal Governments
 
   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 58,000,000 0 0 58,000,000 0 0
Annual IC Time Burden (Hours) 3,558,834 0 0 3,558,834 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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