Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction
1 User Survey Questions-Query FINAL For Clearance User Survey Questions - Query_FINAL_For Clearance.docx Form and Instruction
1 User Survey Questions-Query FINAL For Clearance User Survey Questions - Query_FINAL_For Clearance.docx Form and Instruction
Query Survey Intro-Instructions - FINAL_For Clearance.docx Query Survey Instructions IC Document
Query Survey Intro-Instructions - FINAL_For Clearance.docx Query Survey Instructions IC Document
OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance.docx OMB Fast Track Justification IC Document
OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance.docx OMB Fast Track Justification IC Document
Introductory message from NPDB FINAL_For Clearance.docx Introductory message from NPDB FINAL IC Document
Introductory message from NPDB FINAL_For Clearance.docx Introductory message from NPDB FINAL IC Document
NonSubstantive Change Request.docx Non Substantive Change Request IC Document
NonSubstantive Change Request.docx Non Substantive Change Request IC Document

Information Collection (IC) Details

IC Title:	Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms	Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	User Survey Questions-Query FINAL For Clearance	User Survey Questions - Query_FINAL_For Clearance.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Query Survey Instructions	Query Survey Intro-Instructions - FINAL_For Clearance.docx	12/06/2023
OMB Fast Track Justification	OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance.docx	12/06/2023
Introductory message from NPDB FINAL	Introductory message from NPDB FINAL_For Clearance.docx	12/14/2023
Non Substantive Change Request	NonSubstantive Change Request.docx	12/14/2023

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