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.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form hipdb Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
hipdb hipdb 0239 Forms 2007.doc	Form and Instruction

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: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 61

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
Form and Instruction	hipdb	hipdb	0239 Forms 2007.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Healthcare Integrity and Protection Data Bank (HIPDB), HHS/OIG

FR Citation: 64 FR 7653

Number of Respondents: 54,268

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: 95 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	985,754	39,239	946,515
Annual IC Time Burden (Hours)	120,982	4,836	116,146
Annual IC Cost Burden (Dollars)	3,865,278	-208,722	4,074,000

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.