Indian Health Service Medical Staff Credentials Application

OMB 0917-0009

OMB 0917-0009

This collection of information is used to evaluate individual health care providers applying for medical staff credentials at IHS health care facilities. Provider credentialing in the IHS has been identified as a priority area for quality improvement to support patient safety and demonstrate quality of care. IHS health care facilities require all medical staff applicants to provide information concerning their education, training, licensure, and work experience and any adverse disciplinary actions taken against them. The IHS is transforming credentialing into a centrally installed, automated, standardized, electronic/digital, measurable, portable, accessible, and efficient business process to improve the effectiveness of application and re-application to Medical Staffs, movement of practitioners within the IHS system, and recruitment/retention of high-quality practitioners.

The latest form for Indian Health Service Medical Staff Credentials Application expires 2023-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material
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Supporting Statement A
All Historical Document Collections
Approved with change
Revision of a currently approved collection 2023-08-01
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Revision of a currently approved collection 2020-02-27
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Revision of a currently approved collection 2016-08-11
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Revision of a currently approved collection 2013-06-18
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Extension without change of a currently approved collection 2010-04-30
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Extension without change of a currently approved collection 2006-11-30
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Reinstatement without change of a previously approved collection 2003-06-16
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Extension without change of a currently approved collection 2002-11-27
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Reinstatement with change of a previously approved collection 1999-06-09
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Reinstatement with change of a previously approved collection 1995-07-20
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Extension without change of a currently approved collection 1991-08-16
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No material or nonsubstantive change to a currently approved collection 1989-04-18
Approved with change
No material or nonsubstantive change to a currently approved collection 1989-04-04
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New collection (Request for a new OMB Control Number) 1988-06-15
OMB Details

Indian Health Service Medical Staff Credentials and Privileges Files

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0917-0009-1Application for Medical Staff Appointment and/or Privilegeswww.ihs.gov/RiskManagement/index.cfm?module=dsp_rm_resourcesForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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