Health Insurance Claim Form, HCFA 1450

Health Insurance Claim Form, HCFA 1450

OMB: 0720-0013

IC ID: 5581

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Health Insurance Claim Form, HCFA 1450
 
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 UB-92 Yes Yes
Form HCFA-1450 Yes Yes


    

7,836 0
   
Individuals or Households
 
   6 %

  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 21,100,000 0 19,000,000 0 0 2,100,000
Annual IC Time Burden (Hours) 525,000 0 0 0 0 525,000
Annual IC Cost Burden (Dollars) 893,000 0 34,000 0 0 859,000

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

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