View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Report Forms
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 Adverse Action Reports Module AAR Questions (2)_V6 - for OMB Clearance.docx Yes Yes Fillable Fileable
Form and Instruction 5 Closing Questions Closing Questions (5) - All Respondents_V6 - for OMB Clearance.docx Yes Yes Fillable Fileable
Form and Instruction 4 Judgment or Conviction Reports Module JOCR Questions (4)_V6 - for OMB Clearance.docx Yes Yes Fillable Fileable
Form and Instruction 3 Medical Malpractice Payment Reports Module MMPR Questions (3)_V6 - for OMB Clearance.docx Yes Yes Fillable Fileable
Form and Instruction 1 Opening Questions Opening Questions (1) - All Respondents_V6 - for OMB Clearance.docx Yes Yes Fillable Fileable
Instruction Report Survey Intro-Instructions - for OMB Clearance.docx Yes Yes Fillable Fileable

Health Health Care Services

 

159 0
   
Individuals or Households
 
   100 %

  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 159 0 159 0 0 0
Annual IC Time Burden (Hours) 33 0 33 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Introductory Email Introductory eMail_Reports Survey - for OMB Clearance.docx 03/14/2024
Introductory E-mail for Users Who Received Query Survey Introductory eMail_Reports Survey - User who received Query Survey - for OMB Clearance.docx 03/14/2024
Fast Track Memo OMB Fast Track Memo_Infostatica_Request for Approval_Report Survey_Clean.docx 03/14/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.