Information Collection

Uniform Data System (inclusive of Universal and Grant Report)

IC 6420 under ICR 202606-0915-002 · OMB 0915-0193.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 UDS Tables - BPHC - UDS - 0915-0193 - Revision – 06.15.2026 (Clean Version) Uniform Data System (inclusive of Universal and Grant Report)	Form and Instruction
Form 1 UDS Tables - BPHC - UDS - 0915-0193 - Revision – 08.12.2026 (Clean Version) Uniform Data System (inclusive of Universal and Grant Report)	Form and Instruction
1 UDS Tables - BPHC - UDS - 0915-0193 - Revision – 06.15.2 UDS Tables - BPHC - UDS - 0915-0193 - Revision – 06.15.2026 Clean.docx	Form and Instruction
1 UDS Tables - BPHC - UDS - 0915-0193 - Revision – 08.12.2 2026UDSTables_Final_CLEAN_08122026.docx	Form and Instruction
UDS Tables - BPHC - UDS - 0915-0193 - Revision – redline.pdf UDS Tables - BPHC - UDS - 0915-0193 - Revision - 06.15.2026 (Redline Version)	IC Document
2026UDSTables_Final_trackchanges 08122026.pdf UDS Tables - BPHC - UDS - 0915-0193 - Revision - 08.12.2026 (Redline Version)	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,015

Number of Respondents for Small Entity: 2,015

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,107	149	1,958
Annual IC Time Burden (Hours)	304,616	-72,701	377,317
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
UDS Tables - BPHC - UDS - 0915-0193 - Revision - 08.12.2026 (Redline Version)		08/19/2026

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

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