View Information Collection Request (ICR) Package
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Brief and OIRA conclusion
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FR Notices/Comments
IC List
Burden
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Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0917-0009
ICR Reference No:
201004-0917-003
Status:
Historical Active
Previous ICR Reference No:
200611-0917-002
Agency/Subagency:
HHS/IHS
Agency Tracking No:
Title:
Indian Health Service Medical Staff Credentials and Privileges Files
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/03/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/30/2010
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2013
36 Months From Approved
06/30/2010
Responses
3,089
0
3,265
Time Burden (Hours)
1,791
0
1,929
Cost Burden (Dollars)
0
0
0
Abstract:
Information is needed and used by the Indian Health Service Medical Staff to meet JCAHO accreditation requirements and to review, evaluate and verify the credentials, training, and experience of applicants applying for medical staff privileges at IHS health care facilities.
Authorizing Statute(s):
US Code:
25 USC 13
Name of Law: Synder Act
US Code:
42 USC 2001-2004
Name of Law: IHS Transfer Act
US Code:
25 USC 450
Name of Law: Indian Self-Determination and Education Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
74 FR 63754
12/04/2009
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 16139
03/31/2010
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
Anesthesis
NA
Anesthesia Privileges Request Form
Audiology
NA
Audiologic Privileges Request Form
Dental Privileges
NA
Dental Privileges Request Form
Indian Health Service Medical Staff Credentials and Privileges Files
NA
Application for Medical Staff Appointment and/or Privileges
Internal Medicine/Family Practice Privilege
NA
Medical Privileges Request Form
OB-GYN
NA
OB-GYN Privileges Request Form
Optometry
NA
Optometric Privileges Request Form
Pathology
NA
Pathology Privileges Request Form
Podiatry
NA
podiatric Privileges Request Form
Psychiatry
NA
Psychiatric Privileges Request Form
Psychology
NA
Psychology Privileges Request Form
Radiology
NA
Radiology Privileges Request Form
Reaapointment Request
NA
Request for Reappointment To The Medical Staff
Reference Letter
NA
Suggested Format for Letter to Be Sent to References of Applicants or For Telephone Solicitation of References
Surgery
NA
Surgical Privileges Request Form
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
3,089
3,265
0
-176
0
0
Annual Time Burden (Hours)
1,791
1,929
0
-138
0
0
Annual Cost Burden (Dollars)
0
0
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:
Yes
Burden Reduction Due to:
Cutting Redundancy
Short Statement:
The forms were made more streamline.
Annual Cost to Federal Government:
$182,500
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
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]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Saleda Perryman
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
04/30/2010
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