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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Health Integrity and Protection Data Bank for Final Adverse Information on Health Care Providers, Suppliers and Practitioners
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
45 CFR 61
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
hipdb_001
hipdb_001
NPDB-HIPDB_1_Updated.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
hipdb_002
hipdb_002
NPDB-HIPDB_2_Updated.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
hipdb_eauth_001
hipdb_eauth_001
NPDBRegCertOfficial-DBAdmin_v1-0b_20100607_001.doc
Yes
Yes
Fillable Fileable
Instruction
NPDB-HIPDB Subscriber Agreement-NonPayingUsers_1-0h_20100607b_002.doc
Yes
No
Printable Only
Instruction
NPDB-HIPDB Subscriber Agreement-SelfQuery_1-0d_20100611b.doc
Yes
No
Printable Only
Form and Instruction
hipdb_eauth_003
hipdb_eauth_003
NPDBRegAdminv_1-0g_20100607.doc
Yes
Yes
Fillable Fileable
Form and Instruction
hipdb_eauth_002
hipdb_eauth_002
NPDBRegCertOfficial_v1-0g_20100607.doc
Yes
Yes
Fillable Fileable
Form and Instruction
hipdb_eauth_004
hipdb_eauth_004
NPDBRegInvestigativeSearch_1-0g_20100611.doc
Yes
Yes
Fillable Fileable
Form and Instruction
hipdb_eauth_005
hipdb_eauth_005
NPDBRegSelf-Query_v1-0a_20100524.doc
Yes
Yes
Fillable Fileable
Form and Instruction
hipdb_eauth_006
hipdb_eauth_006
NPDBRegUser_v1-0g_20100611.doc
Yes
Yes
Fillable Fileable
Form and Instruction
hipdb_eauth_007
hipdb_eauth_007
NPDBRegUserNotary_v1-0d_20100611.doc
Yes
Yes
Fillable Fileable
Form and Instruction
hipdb_eauth_008
hipdb_eauth_008
NPDBRevokeAccount_1-0b_20100514ks.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Healthcare Integrity and Protection Data Bank (HIPDB), HHS/OIG
FR Citation:
64 FR 7653
Number of Respondents:
54,268
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
95 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
985,754
0
0
0
0
985,754
Annual IC Time Burden (Hours)
146,190
0
25,208
0
0
120,982
Annual IC Cost Burden (Dollars)
4,980,736
0
1,115,458
0
0
3,865,278
Documents for IC
Title
Document
Date Uploaded
Registration Practices Statement
NPDB_RPS_003_policy statement.doc
10/20/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.