Prepare and transmit UB-04 or State File for Inpatient and Ambulatory

National Hospital Care Survey

OMB: 0920-0212

IC ID: 186282

Information Collection (IC) Details

View Information Collection (IC)

Prepare and transmit UB-04 or State File for Inpatient and Ambulatory 0920-0212
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0212 Att K - Monthly Data Transmission of UB-04 Data Att K - Monthly Data Transmission of UB-04 Data.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0167 Health Resources Utilization Statistics  49 FR 37693

408 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,896 0 108 0 0 4,788
Annual IC Time Burden (Hours) 4,896 0 108 0 0 4,788
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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