Information Collection

National Practitioner Data Bank, Section 1921

IC 191868 under ICR 201001-0915-002 · OMB 0915-0331.

Documents and Forms

Document Name Document Type
Form npdb1 National Practitioner Data Bank, Section 1921 Form and Instruction
npdb1 npdb1 npdb info1.pdf Form and Instruction
npdb2 npdb2 npdb info2.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Practitioner Data Bank, Section 1921	Agency IC Tracking Number:

Is this a Common Form?		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 60.6(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	npdb1	npdb1	npdb info1.pdf		Yes	Yes	Fillable Fileable Signable
Form and Instruction	npdb2	npdb2	npdb info2.pdf		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	FR Citation: 62 FR 12653

Number of Respondents: 11,557	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	123,274	123,274
Annual IC Time Burden (Hours)	10,429	10,429
Annual IC Cost Burden (Dollars)	560,000	560,000

Documents for IC

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.