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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0915-0126 NPDB For NPDB Forms	Form	Modified	Available
Form NPDB Identity Proo NPDB Identity Proofing Forms	Form and Instruction	Modified	Available
Form 3 60.10: Adverse Actions - Peer Review Organizations	Form and Instruction	New	Available
Form 1 60.9: Licensure Actions	Form and Instruction	New	Available
Form 2 60.10: Adverse Actions - Private Accreditation	Form and Instruction	New	Available
Justification Memo.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-09-16	Available
0915-0126_Form Changes From 2007 to 2010_Revision.9.1.10.doc	Supplementary Document	Uploaded 2010-09-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6361	National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract	Form	Modified	NPDB Forms
6361	National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract	Form and Instruction	Modified	NPDB Identity Proofing Forms
199299	Section 1921 forms	Form and Instruction	New	60.10: Adverse Actions - Peer Review Organizations
199299	Section 1921 forms	Form and Instruction	New	60.9: Licensure Actions
199299	Section 1921 forms	Form and Instruction	New	60.10: Adverse Actions - Private Accreditation

ICR Details

OMB Control No: 0915-0126	ICR Reference No: 201109-0915-001
Status: Historical Active	Previous ICR Reference No: 201009-0915-005
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: Regulations and Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/25/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/19/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	12/31/2013	12/31/2013
Responses	3,720,492	0	3,720,431
Time Burden (Hours)	324,823	0	324,777
Cost Burden (Dollars)	16,732,083	0	16,732,083

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Abstract: The National Practitioner Data Bank (NPDB) is required to receive and release under 45 CFR Part 60 certain adverse data regarding physicians, dentists, and other licensed health care practitioners. Data collected on adverse actions and information relating to the professional competence and condcut of physicians and other health care practitioners will be shared with hospitals, licensing boards, professional societies, and selected health providers. These data will be used to maintain and improve health care and will be obtained from insurers, licensure boards, hospitals, and other providers.

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Authorizing Statute(s): PL: Pub.L. 99 - 660 402 Name of Law: Health Care Quality Improvement Act of 1986
  

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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract	NPDB Identity Proofing Forms, 0915-0126 NPDB Forms	NPDB Identity Proofing Forms ,   NPDB Forms
Section 1921 forms	2, 1, 3	60.10: Adverse Actions - Private Accreditation ,   60.9: Licensure Actions ,   60.10: Adverse Actions - Peer Review Organizations

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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	3,720,492	3,720,431	0	0	61	0
Annual Time Burden (Hours)	324,823	324,777	0	0	46	0
Annual Cost Burden (Dollars)	16,732,083	16,732,083	0	0	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: 09/19/2011

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