Prepare and transmit UB-04 for Inpatient and Ambulatory

National Hospital Care Survey

Att P - Monthly Data Trans of UB-04 Data

Prepare and transmit UB-04 for Inpatient and Ambulatory

OMB: 0920-0212

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Attachment K Sample Listing Sheet NHDS Redesign OMB No. 0920-0212: Approval expires 10/31/2011

Notice - Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to: CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0212).


Assurances of Confidentiality – All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).


Approximately 481 hospitals will be asked to transmit all inpatient and ambulatory UB-04 claims data on a monthly basis. We expect that hospital staff will take an average of 1 hour to prepare and transit the data files. This equals 5,772 annualized hours over three years.


10/20/09

File Typeapplication/msword
File TitleATTACHMENT O
AuthorChristine Lucas
Last Modified ByCDC User
File Modified2015-01-27
File Created2014-06-19

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