Information Collection

Uniform Data System

IC 6420 under ICR 201901-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1R Uniform Data System	Form and Instruction
1R 0193 2019 UDS Tables (redline).docx 0193 2019 UDS Tables (redline) 12.19.18.docx	Form and Instruction
1C 0193 2019 UDS Tables (clean).docx 0193 2019 UDS Tables (clean) 12.19.18.docx	Form and Instruction
0193 2019 UDS Manual (redline) 12.21.18.docx UDS Manual Redline	IC Document
0193 2019 UDS Manual (clean) 12.21.18.docx UDS Manual Clean	IC Document

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 51c 42 CFR 56 (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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1R	0193 2019 UDS Tables (redline).docx	0193 2019 UDS Tables (redline) 12.19.18.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1C	0193 2019 UDS Tables (clean).docx	0193 2019 UDS Tables (clean) 12.19.18.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,043

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	Previously Approved
Annual Number of Responses for this IC	2,043	68	1,975
Annual IC Time Burden (Hours)	344,807	87,095	257,712
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
UDS Manual Redline	0193 2019 UDS Manual (redline) 12.21.18.docx	01/28/2019
UDS Manual Clean	0193 2019 UDS Manual (clean) 12.21.18.docx	01/28/2019

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