National Provider Identifier (NPI) Application and Update Form

National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406 (CMS-10114)

Documents and Forms

Document Name Document Type
Form CMS-10114 National Provider Identifier (NPI) Application and Update Form Form and Instruction
CMS-10114 NPI Application and Update Form CMS-10114 - NPI Application Change Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	National Provider Identifier (NPI) Application and Update Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 142.408 45 CFR 162.408 45 CFR 162.406

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10114	NPI Application and Update Form	CMS-10114 - NPI Application Change Form.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 767,803	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: 95 %

	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	767,803	175,889	591,914
Annual IC Time Burden (Hours)	130,527	29,901	100,626
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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