Information Collection

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

IC 6485 under ICR 201010-0915-005 · OMB 0915-0239.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form hipdb_001 hipdb_001 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_002 hipdb_002 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_eauth_001 hipdb_eauth_001 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_eauth_003 hipdb_eauth_003 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_eauth_002 hipdb_eauth_002 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_eauth_004 hipdb_eauth_004 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_eauth_005 hipdb_eauth_005 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_eauth_006 hipdb_eauth_006 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_eauth_007 hipdb_eauth_007 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
Form hipdb_eauth_008 hipdb_eauth_008 Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Form and Instruction
NPDB-HIPDB Subscriber Agreement-NonPayingUsers_1-0h_20100607b_002.doc	Instruction
NPDB-HIPDB Subscriber Agreement-SelfQuery_1-0d_20100611b.doc	Instruction
hipdb_001 hipdb_001 NPDB-HIPDB_1_Updated.pdf	Form and Instruction
hipdb_002 hipdb_002 NPDB-HIPDB_2_Updated.pdf	Form and Instruction
hipdb_eauth_001 hipdb_eauth_001 NPDBRegCertOfficial-DBAdmin_v1-0b_20100607_001.doc	Form and Instruction
hipdb_eauth_003 hipdb_eauth_003 NPDBRegAdminv_1-0g_20100607.doc	Form and Instruction
hipdb_eauth_002 hipdb_eauth_002 NPDBRegCertOfficial_v1-0g_20100607.doc	Form and Instruction
hipdb_eauth_004 hipdb_eauth_004 NPDBRegInvestigativeSearch_1-0g_20100611.doc	Form and Instruction
hipdb_eauth_005 hipdb_eauth_005 NPDBRegSelf-Query_v1-0a_20100524.doc	Form and Instruction
hipdb_eauth_006 hipdb_eauth_006 NPDBRegUser_v1-0g_20100611.doc	Form and Instruction
hipdb_eauth_007 hipdb_eauth_007 NPDBRegUserNotary_v1-0d_20100611.doc	Form and Instruction
hipdb_eauth_008 hipdb_eauth_008 NPDBRevokeAccount_1-0b_20100514ks.doc	Form and Instruction
NPDB_RPS_003_policy statement.doc Registration Practices Statement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	hipdb_001	Yes	Yes	Fillable Fileable
Form and Instruction	hipdb_002	Yes	Yes	Fillable Fileable
Form and Instruction	hipdb_eauth_001	Yes	Yes	Fillable Fileable
Instruction		Yes	No	Printable Only
Instruction		Yes	No	Printable Only
Form and Instruction	hipdb_eauth_003	Yes	Yes	Fillable Fileable
Form and Instruction	hipdb_eauth_002	Yes	Yes	Fillable Fileable
Form and Instruction	hipdb_eauth_004	Yes	Yes	Fillable Fileable
Form and Instruction	hipdb_eauth_005	Yes	Yes	Fillable Fileable
Form and Instruction	hipdb_eauth_006	Yes	Yes	Fillable Fileable
Form and Instruction	hipdb_eauth_007	Yes	Yes	Fillable Fileable
Form and Instruction	hipdb_eauth_008	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	985,754	0	985,754
Annual IC Time Burden (Hours)	146,190	25,208	120,982
Annual IC Cost Burden (Dollars)	4,980,736	1,115,458	3,865,278

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Registration Practices Statement		10/20/2010

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

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