Information Collection

Managed Care Data Using the Uniform Institutional Providers Form

IC 37903 under ICR 199909-0938-013 · OMB 0938-0711.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0711 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Managed Care Data Using the Uniform Institutional Providers Form	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	HCFA-R-224				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 96 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1	0	1
Annual IC Time Burden (Hours)	6,547	0	6,547
Annual IC Cost Burden (Dollars)	0	-43,000,000,000	43,000,000,000

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.