Health Insurance Claim Form, HCFA 1450

Health Insurance Claim Form, HCFA 1450

OMB: 0720-0013

IC ID: 5581

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Information Collection (IC) Details

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Health Insurance Claim Form, HCFA 1450
 
No Modified
 
Required to Obtain or Retain Benefits
 
32 CFR 199.7

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction UB-92 HCFA-1450 Health Insurance Claim Form UB-92 HCFA-1450.doc Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

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

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