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: 0906-0081

IC ID: 245415

Documents and Forms
Information Collection (IC) Details

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Other Eligible Entity Attestation
 
No Modified
 
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.pdf Other Eligible Entity Attestation.pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety

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

4,790 500
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 4,790 0 2,906 0 0 1,884
Annual IC Time Burden (Hours) 4,790 0 2,906 0 0 1,884
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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