OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Health Insurance Claims Form, UB-04 CMS 1450

OMB 0938-0997 ยท DOD/DODOASHA.

OMB 0938-0997

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-1450 (UB04) Fr Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5Form and Instruction
Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202401-0720-001CF RCF Recertification 2024-01-02 Approved
202306-0938-002 Revision of a currently approved collection 2023-06-07 Approved without change
202008-0720-002CF RCF New 2020-08-28 Approved without change
202007-0938-008 Extension without change of a currently approved collection 2020-07-27 Approved without change
201907-0938-003 Extension without change of a currently approved collection 2019-07-24 Approved with change
201602-0938-007 Extension without change of a currently approved collection 2016-02-18 Approved with change
201303-0938-010 Reinstatement without change of a previously approved collection 2013-03-13 Approved without change
200908-0938-011 Extension without change of a currently approved collection 2009-08-28 Approved without change
200709-0938-003 No material or nonsubstantive change to a currently approved collection 2007-09-24 Approved without change
200701-0938-014 No material or nonsubstantive change to a currently approved collection 2007-01-19 Approved without change
200605-0938-009 New collection (Request for a new OMB Control Number) 2006-05-30 Approved without change