Justification Memo

DATE: September 15, 2011

FROM: Reports Clearance Officer, HRSA

TO: Office of Information and Regulatory Affairs, OMB

SUBJECT: HRSA Request for Non-Substantive Change to the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: Regulations and Forms (OMB Control No. 0915-0126)

The Health Resources and Services Administration (HRSA) is requesting Office of Management and Budget (OMB) review and approval of a non-substantive change to the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners. Specifically, HRSA is requesting to merge three forms and their associated burden included in OMB Control No. 0915-0331 into OMB Control No. 0915-0126, per OMB’s request.

On March 15, 2010, a Notice of Action was issued for 0915-0331. The package was approved, with the following Terms of Clearance Statement:

“This ICR is approved without change, consistent with the final rule it is associated with. HRSA agrees to merge this burden into 0915-0126 as soon as practicable and before this 18 month approval has expired. In doing so, HRSA may submit the burden merger as a non-substantive change request. Once the burden has been merged into 0915-0126, HRSA agrees to promptly discontinue this ICR so that the burden is not double-counted.”

Many of the forms and associated burden estimates from package 0915-0331 have already been incorporated into either 0915-0126 or another related package, titled “Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers, and Practitioners” (0915-0239).

The following forms that HRSA is requesting to be merged from 0915-0331 and into 0915-0126 are listed below:

• 60.9 – Licensure Actions

• 60.10 – Adverse Action Private Accreditation Entities

• 60.10 – Adverse Actions Peer Review Organizations

The total burden hours associated with each of the forms are shown below:

Instrument	Number of Respondents	Responses per Respondent	Total Responses	Hours per Response	Total Burden Hours
60.9 Licensure Actions	01	01	01	01	01
60.10 Adverse Actions Private Accreditation Entities	11	1	11	.75	8.25
60.10 Adverse Actions Peer Review Organizations	25	2	50	.75	37.5
Total					45.75

1. Burden already included in the estimate for reporting adverse licensure actions to the HIPDB in 45 CFR Part 61 (OMB #0915-0239)

The addition of these forms results in an increase of 45.75 burden hours to the package. Thus, the total burden hours requested for this package are 324,823.

Please let me know if you have any questions.

Thank you.

Carla Haddad

Carla Haddad, MPH

Public Health Analyst

Office of Planning, Analysis and Evaluation

Health Resources and Services Administration

5600 Fishers Lane, Rm 10-49

Rockville, MD 20857

Phone: (301) 443-0165

Email: [email protected]