OMB control number
Health Insurance Claims Form, UB-04 CMS 1450
OMB 0938-0997 · DOD/DODOASHA.
OMB 0938-0997
Latest Forms, Documents, and Supporting Material
Form CMS-1450 (UB04) Fr Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5
Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 All Historical Document Collections
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Approved |
RCF Recertification | 2024-01-02 | |
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Approved without change |
Revision of a currently approved collection | 2023-06-07 | |
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Approved without change |
RCF New | 2020-08-28 | |
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Approved without change |
Extension without change of a currently approved collection | 2020-07-27 | |
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Approved with change |
Extension without change of a currently approved collection | 2019-07-24 | |
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Approved with change |
Extension without change of a currently approved collection | 2016-02-18 | |
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Approved without change |
Reinstatement without change of a previously approved collection | 2013-03-13 | |
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Approved without change |
Extension without change of a currently approved collection | 2009-08-28 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2007-09-24 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2007-01-19 | |
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Approved without change |
New collection (Request for a new OMB Control Number) | 2006-05-30 |