Information Collection

Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5

IC 43681 under ICR 200605-0938-009 · OMB 0938-0997.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0997 can be found here:

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Information Collection (IC) Details

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IC Title:	Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-1450(UB-04)				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53,111	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	179,489,721	179,489,721
Annual IC Time Burden (Hours)	308,237	308,237
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

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