Other Eligible Entity Attestation

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: 245415

Information Collection (IC) Details

View Information Collection (IC)

Other Eligible Entity Attestation
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 44 Other Eligible Entity Attestation_0915-0126.pdf Other Eligible Entity Attestation_0915-0126.pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

1,884 100
   
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 1,884 0 1,884 0 0 0
Annual IC Time Burden (Hours) 1,884 0 1,884 0 0 0
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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