National Practitioner Data Bank (NPDB) Attestation of Reports by Hospitals, Medical Malpractice Payers, Health Plans, and Certain Other Health Care Entities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 National Practitioner Data Bank (NPDB) Attestation of Reports by Hospitals, Medical Malpractice Payers, Health Plans, and Certain Other Health Care Entities	Form and Instruction	Unchanged	Available
GenericAttestationSideBySideComparisonNov2017.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2017-12-04	Available
HC Attestation Revisions_Nov2017.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-12-04	Available
HealthCenterAttestationSideBySideComparison_Nov2017.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2017-12-04	Available
NonSubChangeMemo_OMB_0906-0028_final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-12-04	Available
Generic Attestation Revisions_Nov2017.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-12-04	Available
NPDB SORN 09-15-0054.pdf	Supplementary Document	Uploaded 2017-05-15	Available
PRIVACY IMPACT ASSESSMENTbhw-npdb.pdf	Supplementary Document	Uploaded 2016-10-28	Available
FINALSupportingStatementA 2016.07.14.docx	Supporting Statement A	Uploaded 2016-10-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224198	National Practitioner Data Bank (NPDB) Attestation of Reports by Hospitals, Medical Malpractice Payers, Health Plans, and Certain Other Health Care Entities	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0906-0028	ICR Reference No: 201712-0906-001
Status: Historical Active	Previous ICR Reference No: 201610-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: National Practitioner Data Bank (NPDB) Attestation of Reports by Hospitals, Medical Malpractice Payers, Health Plans, and Certain Other Health Care Entities
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: 12/05/2017
	Date Received in OIRA: 12/05/2017
Terms of Clearance: Updates to the attestations must be incorporated into the primary ICs upon revision/extension.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	05/31/2020	05/31/2020
Responses	6,735	0	6,735
Time Burden (Hours)	6,735	0	6,735
Cost Burden (Dollars)	0	0	0

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Abstract: The National Practitioner Data Bank (NPDB) plans to collect data from hospitals, medical malpractice payers, health plans, and certain other health care entities that are subject to NPDB reporting requirements to assist these entities in understanding and meeting their reporting requirements to the NPDB. The NPDB currently collects similar data from state licensing boards on a regular basis, and this information collection request would expand beyond current compliance activities to include hospitals, medical malpractice payers, health plans, and certain health care entities.

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Authorizing Statute(s): PL: Pub.L. 100 - 93 5 Name of Law: Medicare and Medicaid Patient and Program Protection Act of 1987
   PL: Pub.L. 100 - 93 1921 Name of Law: Social Security Act
   PL: Pub.L. 100 - 93 221(a) Name of Law: Health Insurance Portability and Accountability Act of 1996
   PL: Pub.L. 104 - 191 1128E Name of Law: Social Security Act
   PL: Pub.L. 99 - 660 Title IV Name of Law: Health Care Quality Improvement Act of 1986, as amended
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 37613	06/10/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 71745	10/18/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
National Practitioner Data Bank (NPDB) Attestation of Reports by Hospitals, Medical Malpractice Payers, Health Plans, and Certain Other Health Care Entities	1, 3, 2	Revised_OMB_Generic ,   HC Add a Site.pdf ,   HC Attestation _v2.pdf

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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	6,735	6,735	0	0	0	0
Annual Time Burden (Hours)	6,735	6,735	0	0	0	0
Annual Cost Burden (Dollars)	0	0	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: This is a new ICR, an increase from zero (0).

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Annual Cost to Federal Government: $3,300,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 12/05/2017

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