Information Collection

Health Plan Identifier, Other Entity Identifier, National Provider Identifier Application

IC 204281 under ICR 201209-0938-009 · OMB 0938-1166.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Health Plan Identifier, Other Entity Identifier, National Provider Identifier Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 162.410 45 CFR 162.512

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 175,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	175,000	175,000
Annual IC Time Burden (Hours)	60,300	60,300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.