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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Draft 2018 UDS Manual - 09.08.17 (Clean).docx	Yes	Yes	Fillable Fileable
Other-Redline			Draft 2018 UDS Manual - 09.08.17 (Redline).docx	No		Printable Only
Form and Instruction	2	Draft 2018 UDS Tables 09.07.17 (Clean).pdf	Draft 2018 UDS Tables 09.07.17 (Clean).pdf	Yes	Yes	Fillable Fileable
Other-Redline			Draft 2018 UDS Tables 09.07.17 (Redline).docx	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 %

	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

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.