Information Collection

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract

IC 6361 under ICR 200705-0915-002 · OMB 0915-0126.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0126 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0126 Forms 2007.doc	Other-instruction, form, and reports
0126 instruction revisions.doc NPDB revised instructions	IC Document

IC Title:

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 60

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-instruction, form, and reports			0126 Forms 2007.doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners, HHS/HRSA/BHPr

FR Citation: 62 FR 12653

Number of Respondents: 32,389

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,722,202	402,508	3,319,694
Annual IC Time Burden (Hours)	323,694	30,105	293,589
Annual IC Cost Burden (Dollars)	16,740,048	3,232,048	13,508,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NPDB revised instructions	0126 instruction revisions.doc	05/09/2007

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