This requirement
imposes new reporting on hospitals. Because it is new, it is
appropriate that the burden be counted accordingly and not as a
correction error.
Inventory as of this Action
Requested
Previously Approved
10/31/1984
10/31/1984
110,000
0
0
27,500
0
0
0
0
0
THE UNIFORM BILLING CLAIM FORM WILL
ENABLE INSTITUTIONAL MEDICAL PROVIDERS TO SUBMIT CLAIMS FOR
REIMBURSEMENT ON A FORM APPROVED BY THE AMERICA HOSPITAL
ASSOCIATION AND MAJOR THIRD PARTY INSURANCE CARRIERS WHICH WILL
ENSURE PROMPT PAYMENT OF AUTHORIZED CLAIMS.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.