Users, Non-Users, Entities Respondents

Survey of Eligible Users of the National Practitioner Databank

OMB: 0915-0366

IC ID: 207742

Documents and Forms

Document Name Document Type
Form 1 Users, Non-Users, Entities Respondents Form and Instruction
1 Users Non-Users Entites survey screenshots.pdf FORM Attachment 12 Users Non-Users Entites survey screenshots.pdf Form and Instruction
1 Users Non-Users Entites survey screenshots.pdf FORM Attachment 12 Users Non-Users Entites survey screenshots.pdf Form and Instruction
Attachment 10 Entities survey codebook 1-21.pdf Attachment 10 Entities survey codebook 1-21 IC Document
Attachment 10 Entities survey codebook 1-21.pdf Attachment 10 Entities survey codebook 1-21 IC Document
Attachment 14 Email to entities.docx Attachment 14 Email to entities IC Document
Attachment 14 Email to entities.docx Attachment 14 Email to entities IC Document
Attachment 15 Telephone non users.docx Attachment 15 Telephone non users IC Document
Attachment 15 Telephone non users.docx Attachment 15 Telephone non users IC Document
1 Entities_Flowchart.pdf 1 Entities_Flowchart IC Document
1 Entities_Flowchart.pdf 1 Entities_Flowchart IC Document
1 Welcome Page.docx 1 Welcome Page IC Document
1 Welcome Page.docx 1 Welcome Page IC Document
2 Demographics.docx 2 Demographics IC Document
2 Demographics.docx 2 Demographics IC Document
3 Demographics - Hospitals.docx 3 Demographics - Hospitals IC Document
3 Demographics - Hospitals.docx 3 Demographics - Hospitals IC Document
4 Demographics - Several entities.docx 4 Demographics - Several entities IC Document
4 Demographics - Several entities.docx 4 Demographics - Several entities IC Document
5 Demographics - Professional society.docx 5 Demographics - Professional society IC Document
5 Demographics - Professional society.docx 5 Demographics - Professional society IC Document
6 Demographics - State licensing certification.docx 6 Demographics - State licensing certification IC Document
6 Demographics - State licensing certification.docx 6 Demographics - State licensing certification IC Document
7 Demographics - Prosecutor.docx 7 Demographics - Prosecutor IC Document
7 Demographics - Prosecutor.docx 7 Demographics - Prosecutor IC Document
8 Query - Intro.docx 8 Query - Intro IC Document
8 Query - Intro.docx 8 Query - Intro IC Document
9 Query - Agent.docx 9 Query - Agent IC Document
9 Query - Agent.docx 9 Query - Agent IC Document
10 Query - Legal requirement.docx 10 Query - Legal requirement IC Document
10 Query - Legal requirement.docx 10 Query - Legal requirement IC Document
11 Query - Experiences.docx 11 Query - Experiences IC Document
11 Query - Experiences.docx 11 Query - Experiences IC Document
12 Query - Satisfaction.docx 12 Query - Satisfaction IC Document
12 Query - Satisfaction.docx 12 Query - Satisfaction IC Document
13 Perceptions.docx 13 Perceptions IC Document
13 Perceptions.docx 13 Perceptions IC Document
14 Matched responses - Intro.docx 14 Matched responses - Intro IC Document
14 Matched responses - Intro.docx 14 Matched responses - Intro IC Document
15 Matched responses - Details.docx 15 Matched responses - Details IC Document
15 Matched responses - Details.docx 15 Matched responses - Details IC Document
16 Reports - Intro.docx 16 Reports - Intro IC Document
16 Reports - Intro.docx 16 Reports - Intro IC Document
17 AAR - Agent.docx 17 AAR - Agent IC Document
17 AAR - Agent.docx 17 AAR - Agent IC Document
18 AAR - Experiences.docx 18 AAR - Experiences IC Document
18 AAR - Experiences.docx 18 AAR - Experiences IC Document
19 Report information.docx 19 Report information IC Document
19 Report information.docx 19 Report information IC Document
20 NPDB Awareness.docx 20 NPDB Awareness IC Document
20 NPDB Awareness.docx 20 NPDB Awareness IC Document
21 Satisfaction with products and services.docx 21 Satisfaction with products and services IC Document
21 Satisfaction with products and services.docx 21 Satisfaction with products and services IC Document
22 NPDB HIPDB Merger.docx 22 NPDB HIPDB Merger IC Document
22 NPDB HIPDB Merger.docx 22 NPDB HIPDB Merger IC Document
23 Attestation Initiative.docx 23 Attestation Initiative IC Document
23 Attestation Initiative.docx 23 Attestation Initiative IC Document
24 Authorized agents - Query intro.docx 24 Authorized agents - Query intro IC Document
24 Authorized agents - Query intro.docx 24 Authorized agents - Query intro IC Document
25 Authorized agents - Query demographics.docx 25 Authorized agents - Query demographics IC Document
25 Authorized agents - Query demographics.docx 25 Authorized agents - Query demographics IC Document
26 Authorized agents - Query experiences.docx 26 Authorized agents - Query experiences IC Document
26 Authorized agents - Query experiences.docx 26 Authorized agents - Query experiences IC Document
27 Authorized agents - Reports intro.docx 27 Authorized agents - Reports intro IC Document
27 Authorized agents - Reports intro.docx 27 Authorized agents - Reports intro IC Document
28 Authorized agents - Report demographics.docx 28 Authorized agents - Report demographics IC Document
28 Authorized agents - Report demographics.docx 28 Authorized agents - Report demographics IC Document
29 Authorized agents - Report experiences.docx 29 Authorized agents - Report experiences IC Document
29 Authorized agents - Report experiences.docx 29 Authorized agents - Report experiences IC Document
30 Attestation - Authorized Agents.docx 30 Attestation - Authorized Agents IC Document
30 Attestation - Authorized Agents.docx 30 Attestation - Authorized Agents IC Document
31 MMPR - Intro.docx 31 MMPR - Intro IC Document
31 MMPR - Intro.docx 31 MMPR - Intro IC Document
32 MMPR - Reason for non-reporting.docx 32 MMPR - Reason for non-reporting IC Document
32 MMPR - Reason for non-reporting.docx 32 MMPR - Reason for non-reporting IC Document
33 MMPR - Experiences.docx 33 MMPR - Experiences IC Document
33 MMPR - Experiences.docx 33 MMPR - Experiences IC Document
34 COVID 19.docx 34 COVID 19 IC Document
34 COVID 19.docx 34 COVID 19 IC Document
35 JOCR - Experiences.docx 35 JOCR - Experiences IC Document
35 JOCR - Experiences.docx 35 JOCR - Experiences IC Document
36 End comments.docx 36 End comments IC Document
36 End comments.docx 36 End comments IC Document
37 Software services.docx 37 Software services IC Document
37 Software services.docx 37 Software services IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Users, Non-Users, Entities Respondents	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	1	Users Non-Users Entites survey screenshots.pdf	FORM Attachment 12 Users Non-Users Entites survey screenshots.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:	FR Citation:

Number of Respondents: 15,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	3,750	3,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 10 Entities survey codebook 1-21	Attachment 10 Entities survey codebook 1-21.pdf	02/11/2021
Attachment 14 Email to entities	Attachment 14 Email to entities.docx	02/11/2021
Attachment 15 Telephone non users	Attachment 15 Telephone non users.docx	02/11/2021
1 Entities_Flowchart	1 Entities_Flowchart.pdf	02/11/2021
1 Welcome Page	1 Welcome Page.docx	02/11/2021
2 Demographics	2 Demographics.docx	02/11/2021
3 Demographics - Hospitals	3 Demographics - Hospitals.docx	02/11/2021
4 Demographics - Several entities	4 Demographics - Several entities.docx	02/11/2021
5 Demographics - Professional society	5 Demographics - Professional society.docx	02/11/2021
6 Demographics - State licensing certification	6 Demographics - State licensing certification.docx	02/11/2021
7 Demographics - Prosecutor	7 Demographics - Prosecutor.docx	02/11/2021
8 Query - Intro	8 Query - Intro.docx	02/11/2021
9 Query - Agent	9 Query - Agent.docx	02/11/2021
10 Query - Legal requirement	10 Query - Legal requirement.docx	02/11/2021
11 Query - Experiences	11 Query - Experiences.docx	02/11/2021
12 Query - Satisfaction	12 Query - Satisfaction.docx	02/11/2021
13 Perceptions	13 Perceptions.docx	02/11/2021
14 Matched responses - Intro	14 Matched responses - Intro.docx	02/11/2021
15 Matched responses - Details	15 Matched responses - Details.docx	02/11/2021
16 Reports - Intro	16 Reports - Intro.docx	02/11/2021
17 AAR - Agent	17 AAR - Agent.docx	02/11/2021
18 AAR - Experiences	18 AAR - Experiences.docx	02/11/2021
19 Report information	19 Report information.docx	02/11/2021
20 NPDB Awareness	20 NPDB Awareness.docx	02/11/2021
21 Satisfaction with products and services	21 Satisfaction with products and services.docx	02/11/2021
22 NPDB HIPDB Merger	22 NPDB HIPDB Merger.docx	02/11/2021
23 Attestation Initiative	23 Attestation Initiative.docx	02/11/2021
24 Authorized agents - Query intro	24 Authorized agents - Query intro.docx	02/11/2021
25 Authorized agents - Query demographics	25 Authorized agents - Query demographics.docx	02/11/2021
26 Authorized agents - Query experiences	26 Authorized agents - Query experiences.docx	02/11/2021
27 Authorized agents - Reports intro	27 Authorized agents - Reports intro.docx	02/11/2021
28 Authorized agents - Report demographics	28 Authorized agents - Report demographics.docx	02/11/2021
29 Authorized agents - Report experiences	29 Authorized agents - Report experiences.docx	02/11/2021
30 Attestation - Authorized Agents	30 Attestation - Authorized Agents.docx	02/11/2021
31 MMPR - Intro	31 MMPR - Intro.docx	02/11/2021
32 MMPR - Reason for non-reporting	32 MMPR - Reason for non-reporting.docx	02/11/2021
33 MMPR - Experiences	33 MMPR - Experiences.docx	02/11/2021
34 COVID 19	34 COVID 19.docx	02/11/2021
35 JOCR - Experiences	35 JOCR - Experiences.docx	02/11/2021
36 End comments	36 End comments.docx	02/11/2021
37 Software services	37 Software services.docx	02/11/2021

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