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OMB Control No: 0917-0009	ICR Reference No: 202307-0917-001
Status: Received in OIRA	Previous ICR Reference No: 202002-0917-002
Agency/Subagency: HHS/IHS	Agency Tracking No: 18529
Title: Indian Health Service Medical Staff Credentials Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 08/01/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2024
Responses	24,787	2,700
Time Burden (Hours)	6,747	1,400
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	24,787	2,700	24,787	-2,700
Annual Time Burden (Hours)	6,747	1,400	6,747	-1,400
Annual Cost Burden (Dollars)	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The program changes were necessary. The program is using additional verification methods, and incorporating forms that are necessary for medical verification, and mitigation of issues related to credentialing of medical providers.

Annual Cost to Federal Government: $2,803,420

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Evonne Bennett-Barnes 301 443-4750 evonne.bennett-barnes@ihs.gov