View Information Collection (IC)

View Information Collection (IC)

IC Title:	Uniform Data System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 56 42 CFR 51c (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	UTC Tests - UDS Excel Tool	UDS Excel Tool.xls		Yes	Yes	Fillable Fileable
Form and Instruction	1	2020 UDS Tables REDLINE	2020UDSTables_redlined (002).docx		Yes	Yes	Fillable Fileable
Instruction			2020UDSManual_redlined.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,134	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 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	2,134	0	0	0	0	2,134
Annual IC Time Burden (Hours)	397,644	0	0	0	0	397,644
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
2020 Sept. Change Memo	NSC Change Memo Sept 8 2020- OMB UDS 2020 forms_updated.docx	09/08/2020

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