National Practitioner Data Bank (NPDB) Attestation of Reports by Hospitals, Medical Malpractice Payers, Health Plans, and Certain Other Health Care Entities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0028 can be found here:

Documents and Forms

Document Name Document Type
Form 1 National Practitioner Data Bank (NPDB) Attestation of Reports by Hospitals, Medical Malpractice Payers, Health Plans, and Certain Other Health Care Entities Form and Instruction
1 Revised_OMB_Generic Revised_OMB_Generic.pdf Form and Instruction
2 HC Add a Site.pdf HC Add a Site.pdf Form and Instruction
3 HC Attestation _v2.pdf HC Attestation _v2.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Practitioner Data Bank (NPDB) Attestation of Reports by Hospitals, Medical Malpractice Payers, Health Plans, and Certain Other Health Care Entities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Revised_OMB_Generic	Revised_OMB_Generic.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	HC Add a Site.pdf	HC Add a Site.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	HC Attestation _v2.pdf	HC Attestation _v2.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,735	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,735	6,735
Annual IC Time Burden (Hours)	6,735	6,735
Annual IC Cost Burden (Dollars)	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.