Information Collection

Uniform Data System

IC 6420 under ICR 201709-0915-004 · OMB 0915-0193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0193 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Draft 2018 UDS Tables 09.07.17 (Clean).pdf Uniform Data System	Form and Instruction
Draft 2018 UDS Manual - 09.08.17 (Clean).docx	Instruction
Draft 2018 UDS Manual - 09.08.17 (Redline).docx	Other-Redline
Draft 2018 UDS Tables 09.07.17 (Redline).docx	Other-Redline
2 Draft 2018 UDS Tables 09.07.17 (Clean).pdf Draft 2018 UDS Tables 09.07.17 (Clean).pdf	Form and Instruction

IC Title:

Uniform Data System

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 56 42 CFR 51c (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Fillable Fileable
Other-Redline		No		Printable Only
Form and Instruction	2	Yes	Yes	Fillable Fileable
Other-Redline		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,975

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,975	499	174	1,302
Annual IC Time Burden (Hours)	257,712	25,394	0	232,318
Annual IC Cost Burden (Dollars)	0	-257,796	0	257,796

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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