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

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: Regulations and Forms

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 001_NPDB National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract Form
001_NPDB 001_NPDB 0915-0126_NPDB Forms_2010.pdf Form
0915-0126_Form Changes From 2007 to 2010.docx Changes to Forms from 2007-2010 IC Document

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	001_NPDB	001_NPDB	0915-0126_NPDB Forms_2010.pdf		Yes	Yes	Fillable Fileable

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 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,720,431	-1,771	3,722,202
Annual IC Time Burden (Hours)	323,694	0	323,694
Annual IC Cost Burden (Dollars)	16,732,083	-7,965	16,740,048

Documents for IC

Title	Document	Date Uploaded
Changes to Forms from 2007-2010	0915-0126_Form Changes From 2007 to 2010.docx	07/16/2010

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