Health Insurance Common Claims Forms and Supportiing Regulations in 42 CFR 414.40, 424.32, and 424.44

Health Insurance Common Claims Forms and Supportiing Regulations in 42 CFR 414.40, 424.32, and 424.44

OMB: 0938-0008

IC ID: 7757

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Health Insurance Common Claims Forms and Supportiing Regulations in 42 CFR 414.40, 424.32, and 424.44
 
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-1500 Yes Yes
Form HCFA-1490S Yes Yes
Form HCFA-1490U Yes Yes


    

1,321,417 0
   
Private Sector Businesses or other for-profits
 
   80 %

  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 717,876,097 0 0 22,707,767 0 695,168,330
Annual IC Time Burden (Hours) 44,460,460 0 0 359,798 0 44,100,662
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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