Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0239 can be found here:

Documents and Forms

Document Name Document Type
Form hipdb Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners Form and Instruction
hipdb hipdb 0239 Forms 2007.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 61

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	hipdb	hipdb	0239 Forms 2007.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Healthcare Integrity and Protection Data Bank (HIPDB), HHS/OIG	FR Citation: 64 FR 7653

Number of Respondents: 54,268	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	985,754	39,239	946,515
Annual IC Time Burden (Hours)	120,982	4,836	116,146
Annual IC Cost Burden (Dollars)	3,865,278	-208,722	4,074,000

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.