Approved for use
through 4/91 under the condition that the next submission for OMB
review incorporates requirements for Medicaid use of the UB-82 as
cleared under OMB Control No. 0938-0458.
Inventory as of this Action
Requested
Previously Approved
04/30/1991
04/30/1991
82,895,773
0
0
3,744,125
0
0
0
0
0
THE 1450 IS A CLAIM FORM COMPLETED BY
INSTITUTIONAL PROVIDERS FOR INPATIENT AND OUTPATIENT SERVICES. ALL
INTERMEDIARY PROCESSED MEDICAR CLAIMS ARE BILLED ON THE
HCFA-1450.
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.