Evaluation Survey of Eligible National Practitioner Data Bank 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⚠️ Notice: This information collection may be referencing outdated material.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 0906-0084 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction
1 Query Survey Intro-Instructions Query Survey Intro-Instructions - FINAL_For Clearance.docx Form and Instruction
2 User Survey Questions - Query User Survey Questions - Query_FINAL_For Clearance.docx Form and Instruction
OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance.docx OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance IC Document

Information Collection (IC) Details

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

IC Status: New

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	Query Survey Intro-Instructions	Query Survey Intro-Instructions - FINAL_For Clearance.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	User Survey Questions - Query	User Survey Questions - Query_FINAL_For Clearance.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
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
OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance	OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance.docx	01/09/2024

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