Introduction and Instructions

The National Uniform Claim Committee (NUCC) is conducting the following survey to gather information about the current usage of the 1500 Health Insurance Claim Form (1500 Form), both as a paper form and as a print image.  Information from this survey will be used by the NUCC in its general work on the professional claim and its data content.  This survey is not an indication of any specific changes being considered for the 1500 Form. 

The questions should take approximately 5-10 minutes to complete, although you may need to spend additional time compiling data on your use of 1500 Form prior to answering the questions.  All responses are confidential.  Your identity or the identity of your organization will not be published or released without your permission.  We appreciate your feedback.

If you have any questions about this survey, please email