Division of Practitioner Data Bank (DPDB) Feedback and Satisfaction Surveys

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⚠️ Notice: This information collection may be referencing outdated material.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 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Division of Practitioner Data Bank (DPDB) Feedback and Satisfaction Surveys Form
1 National Practitioner Data Bank (NPDB) Webcast Survey INSTRUMENT.docx Form
SUPPORTING STATEMENT.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Division of Practitioner Data Bank (DPDB) Feedback and Satisfaction Surveys	Agency IC Tracking Number:

IC Status: Unchanged

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	1	National Practitioner Data Bank (NPDB) Webcast Survey	INSTRUMENT.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	SUPPORTING STATEMENT.docx	09/23/2019

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