Medicare Uniform Institutional Provider Bill

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
7933	Medicare Uniform Institutional Provider Bill Form	Migrated

ICR Details

OMB Control No: 0938-0279	ICR Reference No: 199603-0938-004
Status: Historical Inactive	Previous ICR Reference No: 199403-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Uniform Institutional Provider Bill
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 05/10/1996
	Date Received in OIRA: 03/19/1996
Terms of Clearance: OMB returns this HCFA submission as improperly submitted for several reasons: 1) the package sent to OMB and available for public comment does not contain the UB-92 instructions and electronic file structures; 2) the package available for public scrutiny during the agency's 60-day review and the package sent to OMB did not contain all available materials regarding compliance with OMB's previous remarks on the collection of race/ethnicity data (e.g. the OMB clearance number and a copy of HCFA's targetted survey effort and HCFA's Action Plan submitted to OMB. These materials would demonstrate to the public the extent to which HCFA complied with OMB's remarks.);and 3) the package submitted to OMB requests approval for the use of the UB-92 not only for HCFA, but for the CHAMPUS, other DoD, and Indian Health Service programs. HCFA attempts to account for the burden in these programs in this submission. Although OMB may agree with the expanded use of the UB-92 by other Federal programs, OMB is unable to approve such use as presented by HCFA. In its 60-day notice, HCFA did not explain that this submission would seek approval for UB-92 use by three additional programs. The public was denied the opportunity to comment on these uses. To address this last issue, HCFA must proceed with one of the following strategies: 1) resubmit this package for 60-day and OMB review, clearly stating to the public that this submission covers other agency uses. The submission must include all relevant and current agency-specific instructions, electronic file structures, etc. and applicable burden/cost estimates; 2) amend this submission to cover only HCFA uses and proceed with a 60-day agency review before resubmitting to OMB. Other user agencies should submit their own packages including their own instructions, electronic file structures, burden/cost estimates, etc. OMB will assist HCFA in explaining the necessary PRA procedures to these agencies; or 3) the same as option 2, except HCFA amends this package to cover all HHS component uses, including IHS.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This form is the standardized form used in the Medicare/Medicaid program to apply for reimbursement for covered services by all providers that accept medicare/medicaid assigned claims. It will reduce cost and administrative burdens associated with claims since only one coding system is used and maintained.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medicare Uniform Institutional Provider Bill	HCFA-1450

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/19/1996

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