OMB
.report
Search
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: Regulations and Forms
OMB: 0915-0126
IC ID: 6361
OMB.report
HHS/HSA
OMB 0915-0126
ICR 201009-0915-005
IC 6361
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0126 can be found here:
2023-11-09 - Revision of a currently approved collection
2021-01-25 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form NPDB Identity Proo
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract
Form and Instruction
NPDB Identity Proo NPDB Identity Proofing Forms
NPDB-HIPDB E-Authentication and Identity Proofing Forms.doc
Form and Instruction
0915-0126 NPDB For NPDB Forms
0915-0126_NPDB Forms_2010.pdf
Form
0915-0126_Form Changes From 2007 to 2010_Revision.9.1.10.doc
Form Changes from 2007-2010
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
45 CFR 60
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
NPDB Identity Proofing Forms
NPDB Identity Proofing Forms
NPDB-HIPDB E-Authentication and Identity Proofing Forms.doc
Yes
Yes
Fillable Fileable
Form
0915-0126 NPDB Forms
NPDB Forms
0915-0126_NPDB Forms_2010.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners, HHS/HRSA/BHPr
FR Citation:
62 FR 12653
Number of Respondents:
32,389
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
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
3,720,431
0
0
-1,771
0
3,722,202
Annual IC Time Burden (Hours)
324,777
0
1,083
0
0
323,694
Annual IC Cost Burden (Dollars)
16,732,083
0
0
-7,965
0
16,740,048
Documents for IC
Title
Document
Date Uploaded
Form Changes from 2007-2010
0915-0126_Form Changes From 2007 to 2010_Revision.9.1.10.doc
09/07/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.