OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Att R_Monthly Transmission of UB-04 Data

IC 186282 under ICR 202407-0920-002 · OMB 0920-0212.

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

View Information Collection (IC)

Att R_Monthly Transmission of UB-04 Data 0920-0212
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0212 Monthly Data Transmission of UB-04 Data Att R - Monthly Data Transmission of UB-04 Data.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0167 Health Resources Utilization Statistics  49 FR 37693

356 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 4,272 0 -624 0 0 4,896
Annual IC Time Burden (Hours) 4,272 0 -624 0 0 4,896
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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