Indian Health Service Medical Staff Credentials and Privileges Files

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0917-0009supporting st06.doc	Supporting Statement A	Uploaded 2006-11-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6568	Indian Health Service Medical Staff Credentials and Privileges Files		Modified
46256	Pathology		New
46255	Radiology		New
46254	Podiatry		New
46253	Audiology		New
46252	Psychology		New
46251	Optometry		New
46250	Dental Privileges		New
46249	Anesthesis		New
46248	Psychiatry		New
46247	Surgery		New
46246	OB-GYN		New
46245	Internal Medicine/Family Practice Privilege		New
46244	Reaapointment Request		New
46243	Reference Letter		New

ICR Details

OMB Control No: 0917-0009	ICR Reference No: 200611-0917-002
Status: Historical Active	Previous ICR Reference No: 200306-0917-001
Agency/Subagency: HHS/IHS	Agency Tracking No:
Title: Indian Health Service Medical Staff Credentials and Privileges Files
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/26/2007
	Date Received in OIRA: 11/30/2006
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved	01/31/2007
Responses	3,265	0	3,709
Time Burden (Hours)	1,929	0	2,371
Cost Burden (Dollars)	0	0	0

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Abstract: Information is needed and used by the Indian Health Service Medical Staff to meet JCAHO accreditation requirements and to review, evaluate and verify the credentials, training, and experience of applicants applying for medical staff privileges at IHS health care facilities.

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Authorizing Statute(s): US Code: 25 USC 13 Name of Law: Synder Act
   US Code: 42 USC 2001-2004 Name of Law: IHS Transfer Act
   US Code: 25 USC 450 Name of Law: Indian Self-Determination and Education Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 35921	06/22/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 53106	09/08/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
Reference Letter
Reaapointment Request
Internal Medicine/Family Practice Privilege
OB-GYN
Surgery
Psychiatry
Anesthesis
Dental Privileges
Optometry
Psychology
Audiology
Podiatry
Radiology
Pathology
Indian Health Service Medical Staff Credentials and Privileges Files

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,265	3,709	0	-444	0	0
Annual Time Burden (Hours)	1,929	2,371	0	-442	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Cutting Redundancy

Short Statement: The forms were made more streamline.

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Annual Cost to Federal Government: $182

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? Yes

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: 11/29/2006

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