Section 1921 forms

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

OMB: 0915-0126

IC ID: 199299

Information Collection (IC) Details

View Information Collection (IC)

Section 1921 forms
 
No Removed
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 60.10: Adverse Actions - Private Accreditation Accreditation Initial - Organization Subject.pdf Yes Yes Fillable Fileable Signable
Form and Instruction 1 60.9: Licensure Actions State Licensure Initial - Individual Subject.pdf Yes Yes Fillable Fileable Signable
Form and Instruction 3 60.10: Adverse Actions - Peer Review Organizations Peer Review Organization Initial - Individual Subject.pdf Yes Yes Fillable Fileable Signable

Health Public Health Monitoring

 

39 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 -61 0 0 61
Annual IC Time Burden (Hours) 0 0 -46 0 0 46
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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