Quarterly Transmission of UB -04 Data

National Hospital Discharge Survey

OMB: 0920-0212

IC ID: 186284

Information Collection (IC) Details

View Information Collection (IC)

Quarterly Transmission of UB -04 Data
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att H Quarterly Transmission of UB-04 Data.doc Yes Yes Fillable Printable

Health Public Health Monitoring

09-20-0167 Health Resource Utilization Statistics  49 FR 37697

500 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 2,000 0 0 1,652 0 348
Annual IC Time Burden (Hours) 2,000 0 0 1,925 0 75
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att L List of UB04 Data Elements Att L List of UB04 Data Elements.docx 01/05/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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