Criminal Conviction (Guilty Plea or Trial)

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: 206488

Information Collection (IC) Details

View Information Collection (IC)

Criminal Conviction (Guilty Plea or Trial)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 9 Criminal Conviction (Guilty Plea or Trial).pdf Criminal Conviction (Guilty Plea or Trial).pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety

System of Record Notice 09-15-0054  88 FR 17854

1,385 0
   
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 1,385 0 -472 0 0 1,857
Annual IC Time Burden (Hours) 736 0 -146 0 0 882
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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