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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
HospitalRegistrationRenewal
Unchanged
3198
800
0
Form and Instruction
32
HospitalRegistrationRenewal
Account Discrepancy
Unchanged
41
10
0
Form and Instruction
30
Account Discrepancy
Accreditation
Unchanged
12
9
0
Form and Instruction
6
Accreditation
Agent Registration (Initial)
Unchanged
37
37
0
Form and Instruction
26
Agent Registration (Initial)
Agent Registration (Renewal & Update)
Unchanged
3198
800
0
Form and Instruction
27
Agent Registration (Renewal & Update)
Authorized Agent Designation
Unchanged
788
197
0
Form and Instruction
29
Authorized Agent Designation
Civil Judgment
Unchanged
14
11
0
Form and Instruction
13
Civil Judgment
Continuous Query
Unchanged
629921
40693
0
Form and Instruction
21
Continuous Query
Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal
Unchanged
37667
5126
0
Form and Instruction
1
Correction, Revision to Action, Correction of Revision to Action, Void, Notice of Appeal
Corrective Action Plan (Entity)
Unchanged
10
1
0
Form and Instruction
36
Corrective Action Plan (Entity)
Criminal Conviction (Guilty Plea or Trial)
Unchanged
2245
981
0
Form and Instruction
9
Criminal Conviction (Guilty Plea or Trial)
DEA/Federal Licensure
Unchanged
114
86
0
Form and Instruction
4
DEA/Federal Licensure
Deferred Conviction or Pre-Trial Diversion
Unchanged
50
38
0
Form and Instruction
10
Deferred Conviction or Pre-Trial Diversion
Electronic Transfer of Funds (ETF) Authorization
Unchanged
566
45
0
Form and Instruction
28
Electronic Transfer of Funds (ETF) Authorization
Entity Registration (Initial)
Unchanged
524
524
0
Form and Instruction
24
Entity Registration (Initial)
Entity Registration (Renewal & Update)
Unchanged
6383
1596
0
Form and Instruction
25
Entity Registration (Renewal & Update)
Exclusion/Debarment
Unchanged
6279
891
0
Form and Instruction
14
Exclusion/Debarment
Government Administrative
Unchanged
2233
1675
0
Form and Instruction
15
Government Administrative
Health Plan Action
Unchanged
524
393
0
Form and Instruction
16
Health Plan Action
HospitalRegistrationInitial
Unchanged
37
37
0
Form and Instruction
31
31 HospitalRegistrationInitial
Injunction
Unchanged
10
8
0
Form and Instruction
12
Injunction
LicensingBoardAttestation
Unchanged
354
354
0
Form and Instruction
35
LicensingBoardAttestation
LicensingBoardDataRequest
Unchanged
140
1470
0
Form and Instruction
33
LicensingBoardDataRequest
Medical Malpractice Payment
Unchanged
12863
9460
0
Form and Instruction
2
Medical Malpractice Payment
Nolo Contendere (no contest) plea
Unchanged
80
60
0
Form and Instruction
11
Nolo Contendere (no contest) plea
One Time Query for an Individual
Unchanged
4144033
159115
0
Form and Instruction
17
One Time Query for an Individual
One Time Query for an Organization
Unchanged
42186
3195
0
Form and Instruction
18
One Time Query for an Organization
Peer Review Organization
Unchanged
10
8
0
Form and Instruction
5
Peer Review Organization
Professional Society
Unchanged
50
38
0
Form and Instruction
8
Professional Society
ReconcilingMissingActionForm
Unchanged
2176
174
0
Form and Instruction
37
ReconcilingMissingActionForm
ReportingDiscrepancyLetter
Unchanged
389
1556
0
Form and Instruction
34
ReportingDiscrepancyLetter
Request for Secretarial Review
Unchanged
94
752
0
Form and Instruction
23
Request for Secretarial Review
Self-Query on an Individual
Unchanged
77318
32474
0
Form and Instruction
19
Self-Query on an Individual
Self-Query on an Organization
Unchanged
427
427
0
Form and Instruction
20
Self-Query on an Organization
State Licensure
Unchanged
34192
12583
0
Form and Instruction
3
State Licensure
Subject Statement and Dispute
Unchanged
3501
2626
0
Form and Instruction
22
Subject Statement and Dispute
Title IV Clinical Privileges Actions
Unchanged
671
503
0
Form and Instruction
7
Title IV Clinical Privileges Actions
Total burden requested under this ICR:
5012335
278753
0
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