Information Collection Request
Health Insurance Claims Form, UB-04 CMS 1450
ICR 202401-0720-001CF · OMB 0938-0997 · Active
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 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 243027 |  Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 |
Form and Instruction | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | DOD/DODOASHA |
| OMB Control No | 0938-0997 |
| Type of Information Collection | RCF Recertification |
| Previous ICR Reference No | 202008-0720-002CF |
| Date Submitted to OIRA | 2024-01-02 |
| Requested Expiration Date | 1969-12-31 |