Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: 45 CFR Part 60 Regulations and Forms

OMB: 0915-0126

IC ID: 206480

Information Collection (IC) Details

View Information Collection (IC)

Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Correction Revision-to-Action Void Notice of Appeal_0915-0126.pdf Correction Revision-to-Action Void Notice of Appeal_0915-0126.pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

30,219 5,000
   
State, Local, and Tribal Governments
 
   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 30,219 0 1,139 0 0 29,080
Annual IC Time Burden (Hours) 2,985 0 200 0 0 2,785
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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