Prepare and transmit UB-04 for Inpatient and Ambulatory

National Hospital Care Survey

OMB: 0920-0212

IC ID: 186285

Information Collection (IC) Details

View Information Collection (IC)

Prepare and transmit UB-04 for Inpatient and Ambulatory
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Quarterly Transmission of UB-04 Data NHCS 2013 Attac N- Quarterly Data Transmission 011613.doc Yes Yes Fillable Fileable

Health Public Health Monitoring

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

500 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 1,989 0 0 11
Annual IC Time Burden (Hours) 2,000 0 1,989 0 0 11
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att Q - UB-04 Data Elements Attachment Q- List of UB04 Data Elements.docx 01/31/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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