Information Collection

Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners

IC 6485 under ICR 200403-0915-003 · OMB 0915-0239.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0239 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50,811	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	946,515	-335,489	1,282,004
Annual IC Time Burden (Hours)	116,146	-71,023	187,169
Annual IC Cost Burden (Dollars)	4,074,000	1,967,000	2,107,000

Documents for IC

Title	Document	Date Uploaded

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