Information Collection

National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406

IC 37925 under ICR 200703-0938-012 · OMB 0938-0931.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0931 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10114 National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406	Form and Instruction
CMS-10114 NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FO CMS-10114.REVISED-NPI Application.2-28-07.pdf	Form and Instruction
CMS-10114 National Provider Identifier (NPI) Application/Update Fo CMS-10114.FINAL-Revised Form-5-2-07.pdf	Form and Instruction
CMS-10114 (Updated National Provider Identifier (NPI) Application/Update Fo CMS-10114.REVISED Form-5-22-07.pdf	Form and Instruction

IC Title:

National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 142.408 45 CFR 162.406 45 CFR 162.408

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10114	NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FORM	CMS-10114.REVISED-NPI Application.2-28-07.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10114 (Updated)	National Provider Identifier (NPI) Application/Update Form (updated)	CMS-10114.REVISED Form-5-22-07.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10114	National Provider Identifier (NPI) Application/Update Form	CMS-10114.FINAL-Revised Form-5-2-07.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35,880

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35,880	-1,158,065	1,193,945
Annual IC Time Burden (Hours)	11,960	-436,168	448,128
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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