Information Collection

Uniform Data System

IC 6420 under ICR 201912-0915-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Uniform Data System	Form and Instruction
2020 UDS Tables_redline_ 2 5 2020.docx	Other-2020 UDS Tables Redline 2 5 20
2 Grant Report - 2020 UDS Tables Redline 2020 UDS Tables_redline.docx	Form and Instruction
3 UTC Tests - UDS Excel Tool UDS Excel Tool.xls	Form and Instruction
1 2020 UDS Tables_clean_ 2 5 2020.docx 2020 UDS Tables_clean_ 2 5 2020.docx	Form and Instruction
2020 UDS Manual_clean_2 5 2020.docx 2020 UDS Manual_clean_2 5 2020	IC Document
2020 UDS Manual_redline_2 5 2020.docx 2020 UDS Manual_redline_2 5 2020	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 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.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Grant Report - 2020 UDS Tables Redline	2020 UDS Tables_redline.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	UTC Tests - UDS Excel Tool	UDS Excel Tool.xls	Yes	Yes	Fillable Fileable
Form and Instruction	1	2020 UDS Tables_clean_ 2 5 2020.docx	2020 UDS Tables_clean_ 2 5 2020.docx	Yes	Yes	Fillable Fileable
Other-2020 UDS Tables Redline 2 5 20			2020 UDS Tables_redline_ 2 5 2020.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,134

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	2,134	91	2,043
Annual IC Time Burden (Hours)	397,644	52,837	344,807
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2020 UDS Manual_clean_2 5 2020	2020 UDS Manual_clean_2 5 2020.docx	02/06/2020
2020 UDS Manual_redline_2 5 2020	2020 UDS Manual_redline_2 5 2020.docx	02/06/2020

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