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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Account Discrepancy
New
20
5
0
Form and Instruction
30
Account Discrepancy
Accreditation
New
10
8
0
Form and Instruction
6
Accreditation
Agent Registration (Initial)
New
100
25
0
Form and Instruction
26
Agent Registration (Initial)
Agent Registration (Renewal & Update)
New
100
25
0
Form and Instruction
27
Agent Registration (Renewal & Update)
Authorized Agent Designation
New
1290
323
0
Form and Instruction
29
Authorized Agent Designation
Civil Judgment
New
10
8
0
Form and Instruction
13
Civil Judgement
Continuous Query
New
387767
31021
0
Form and Instruction
21
Continuous Query
Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal
New
38785
9696
0
Form and Instruction
1
Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal
Criminal Conviction (Guilty Plea or Trial)
New
1023
767
0
Form and Instruction
9
Criminal Conviction (Guilty Plea or Trial)
DEA/Federal Licensure
New
499
374
0
Form and Instruction
4
DEA/Federal Licensure
Deferred Conviction or Pre-Trial Diversion
New
126
95
0
Form and Instruction
10
Deferred Conviction or Pre-Trial Diversion
Electronic Transfer of Funds (ETF) Authorization
New
562
141
0
Form and Instruction
28
Electronic Transfer of Funds (ETF) Authorization
Entity Registration (Initial)
New
35915
35915
0
Form and Instruction
24
Entity Registration (Initial)
Entity Registration (Renewal & Update)
New
15461
1237
0
Form and Instruction
25
Entity Registration (Renewal & Update)
Exclusion/Debarment
New
2402
1802
0
Form and Instruction
14
Exclusion/Debarment
Government Administrative
New
2682
2012
0
Form and Instruction
15
Government Administrative
Health Plan Action
New
561
421
0
Form and Instruction
16
Health Plan Action
Injunction
New
10
8
0
Form and Instruction
12
Injunction
Medical Malpractice Payment
New
14193
10645
0
Form and Instruction
2
Medical Malpractice Payment
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract
Removed
0
0
0
Form and Instruction
NPDB Identity Proofing Forms
NPDB Identity Proofing Forms
Form
0915-0126 NPDB Forms
NPDB Forms
Nolo Contendere (no contest) plea
New
63
47
0
Form and Instruction
11
Nolo Contendere (no contest) plea
One Time Query for an Individual
New
986552
78924
0
Form and Instruction
17
One Time Query for an Individual
One Time Query for an Organization
New
18892
1511
0
Form and Instruction
18
One Time Query for an Organization
Peer Review Organization
New
10
8
0
Form and Instruction
5
Peer Review Organization
Professional Society
New
71
53
0
Form and Instruction
8
Professional Society
Request for Secretarial Review
New
83
664
0
Form and Instruction
23
Request for Secretarial Review
Section 1921 forms
Removed
0
0
0
Form and Instruction
2
60.10: Adverse Actions - Private Accreditation
Form and Instruction
1
60.9: Licensure Actions
Form and Instruction
3
60.10: Adverse Actions - Peer Review Organizations
Self-Query on an Individual
New
154824
65026
0
Form and Instruction
19
Self-Query on an Individual
Self-Query on an Organization
New
1095
460
0
Form and Instruction
20
Self-Query on an Organization
State Licensure
New
28700
21525
0
Form and Instruction
3
State Licensure
Subject Statement and Dispute
New
3347
2510
0
Form and Instruction
22
Subject Statement and Dispute
Title IV Clinical Privileges Actions
New
962
722
0
Form and Instruction
7
Title IV Clinical Privileges Actions
Total burden requested under this ICR:
1696115
265978
0
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