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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 6485 under ICR 200708-0915-001 · OMB 0915-0239.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners
 
No Modified
 
Mandatory
 
45 CFR 61

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction hipdb hipdb 0239 Forms 2007.doc Yes Yes Fillable Fileable

Health Health Care Services

Healthcare Integrity and Protection Data Bank (HIPDB), HHS/OIG  64 FR 7653

54,268 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   95 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 985,754 0 0 39,239 0 946,515
Annual IC Time Burden (Hours) 120,982 0 0 4,836 0 116,146
Annual IC Cost Burden (Dollars) 3,865,278 0 0 -208,722 0 4,074,000

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