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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form hipdb_eauth_008 hipdb_eauth_008	Form and Instruction	Modified	Available
Form hipdb_eauth_007 hipdb_eauth_007	Form and Instruction	Modified	Available
Form hipdb_eauth_006 hipdb_eauth_006	Form and Instruction	Modified	Available
Form hipdb_eauth_005 hipdb_eauth_005	Form and Instruction	Modified	Available
Form hipdb_eauth_004 hipdb_eauth_004	Form and Instruction	Modified	Available
Form hipdb_eauth_002 hipdb_eauth_002	Form and Instruction	Modified	Available
Form hipdb_eauth_003 hipdb_eauth_003	Form and Instruction	Modified	Available
Form hipdb_eauth_001 hipdb_eauth_001	Form and Instruction	Modified	Available
Form hipdb_002 hipdb_002	Form and Instruction	Modified	Available
Form hipdb_001 hipdb_001	Form and Instruction	Modified	Available
NPDB_RPS_003_policy statement.doc	Supplementary Document	Uploaded 2010-10-20	Available
ss 0239 2010 revised 1 27 11.doc	Supporting Statement A	Uploaded 2011-02-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_eauth_008
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_eauth_007
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_eauth_006
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_eauth_005
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_eauth_004
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_eauth_002
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_eauth_003
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Instruction	Modified
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_eauth_001
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_002
6485	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction	Modified	hipdb_001

ICR Details

OMB Control No: 0915-0239	ICR Reference No: 201010-0915-005
Status: Historical Active	Previous ICR Reference No: 200708-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/06/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/28/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved	05/31/2011
Responses	985,754	0	985,754
Time Burden (Hours)	146,190	0	120,982
Cost Burden (Dollars)	4,980,736	0	3,865,278

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Abstract: Section 1128 E of the Social Security Act directs the Secretary of Health and Human Services to establish a national health care fraud and abuse data collection program for the reporting and disclosure of certain final adverse actions taken against health care providers, suppliers, or practitioners. The Health Integrity and Protection Data Bank (HIPDB)is the database maintaining final adverse actions taken against health care providers, suppliers, or practitioners.

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Authorizing Statute(s): US Code: 42 USC 11101 Name of Law: Health Care Quality Improvement Act of 1986
   PL: Pub.L. 104 - 101 221 Name of Law: Establishment of the Health Care Fraud and Abuse Data Collection Program
   US Code: 42 USC 1301 Name of Law: Health Care and Abuse Data Collection Program
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 29348	05/25/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 62836	10/13/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	hipdb_001, hipdb_002, hipdb_eauth_001, hipdb_eauth_003, hipdb_eauth_002, hipdb_eauth_004, hipdb_eauth_005, hipdb_eauth_006, hipdb_eauth_007, hipdb_eauth_008	hipdb_001 ,   hipdb_002 ,   hipdb_eauth_001 ,   hipdb_eauth_003 ,   hipdb_eauth_002 ,   hipdb_eauth_004 ,   hipdb_eauth_005 ,   hipdb_eauth_006 ,   hipdb_eauth_007 ,   hipdb_eauth_008

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	985,754	985,754	0	0	0	0
Annual Time Burden (Hours)	146,190	120,982	0	25,208	0	0
Annual Cost Burden (Dollars)	4,980,736	3,865,278	0	1,115,458	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/28/2010

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