Information Collection Request
Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 (CMS-1450)
ICR 202306-0938-002 · OMB 0938-0997 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0997 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-1450 (UB04) Fr Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 |
Form and Instruction | Modified | Repair queued |
 Supporting Statement - Part A UB04 - 2023.docx |
Supporting Statement A | Uploaded 2023-06-06 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 43681 |  Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0997 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202007-0938-008 |
| Agency Tracking No | OIT |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |