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

OMB: 0915-0126

IC ID: 6361

Information Collection (IC) Details

View Information Collection (IC)

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract
 
No Modified
 
Mandatory
 
45 CFR 60

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NPDB Identity Proofing Forms NPDB Identity Proofing Forms NPDB-HIPDB E-Authentication and Identity Proofing Forms.doc Yes Yes Fillable Fileable
Form 0915-0126 NPDB Forms NPDB Forms 0915-0126_NPDB Forms_2010.pdf Yes Yes Fillable Fileable

Health Health Care Services

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners, HHS/HRSA/BHPr  62 FR 12653

32,389 0
   
Private Sector Not-for-profit institutions
 
   100 %

  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 3,720,431 0 0 -1,771 0 3,722,202
Annual IC Time Burden (Hours) 324,777 0 1,083 0 0 323,694
Annual IC Cost Burden (Dollars) 16,732,083 0 0 -7,965 0 16,740,048

Title Document Date Uploaded
Form Changes from 2007-2010 0915-0126_Form Changes From 2007 to 2010_Revision.9.1.10.doc 09/07/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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