Billing Code Data: 837I Upload

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.800 Billing Code Data: 837I Upload Form
57.800 Billing Code Data Billing Code Data (UB-04) CSV Template.xlsx Form
Billing Code Data Dictionary.xlsx Billing Code Data Dictionary IC Document

Information Collection (IC) Details

IC Title:	Billing Code Data: 837I Upload	Agency IC Tracking Number:	0920-0666

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	57.800	Billing Code Data	Billing Code Data (UB-04) CSV Template.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	22,000	22,000
Annual IC Time Burden (Hours)	1,833	1,833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Billing Code Data Dictionary	Billing Code Data Dictionary.xlsx	11/04/2024

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