Information Collection

Uniform Data System

IC 6420 under ICR 202009-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 3 Uniform Data System	Form and Instruction
2020UDSManual_redlined.docx	Instruction
3 UTC Tests - UDS Excel Tool UDS Excel Tool.xls	Form and Instruction
1 2020 UDS Tables REDLINE 2020UDSTables_redlined (002).docx	Form and Instruction
NSC Change Memo Sept 8 2020- OMB UDS 2020 forms_updated.docx 2020 Sept. Change Memo	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	3	UTC Tests - UDS Excel Tool	UDS Excel Tool.xls	Yes	Yes	Fillable Fileable
Form and Instruction	1	2020 UDS Tables REDLINE	2020UDSTables_redlined (002).docx	Yes	Yes	Fillable Fileable
Instruction			2020UDSManual_redlined.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	Previously Approved
Annual Number of Responses for this IC	2,134	2,134
Annual IC Time Burden (Hours)	397,644	397,644
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2020 Sept. Change Memo	NSC Change Memo Sept 8 2020- OMB UDS 2020 forms_updated.docx	09/08/2020

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