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Federal forms, ICRs, and supporting documents

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Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5

IC 243027 under ICR 202401-0720-001CF · OMB 0938-0997.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5
 
Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 424.5

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-1450 (UB04) Front Uniform Institutional Providers Form CMS-1450 UB04-front.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-1450 (UB04) Back Uniform Institutional Providers Form CMS-1450 UB04 - Back.pdf Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

10,318 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 858,881 0 0 0 0 858,881
Annual IC Time Burden (Hours) 8,589 0 0 1,395 0 7,194
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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