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Federal forms, ICRs, and supporting documents

Information Collection Request

National Practitioner Data Bank (NPDB) Regulations & VAF 10-0376a, Credentials Transfer Brief

ICR 200504-2900-003 · OMB 2900-0621 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
28883 National Practitioner Data Bank (NPDB) Regulations & VAF 10-0376a, Credentials Transfer Brief Form Migrated
ICR Details
2900-0621 200504-2900-003
Historical Active 200202-2900-003
VA
National Practitioner Data Bank (NPDB) Regulations & VAF 10-0376a, Credentials Transfer Brief
Revision of a currently approved collection   No
Regular
Approved without change 07/01/2005
Retrieve Notice of Action (NOA) 04/14/2005
Approved consistent with VA memo submitted to OMB 06/20/05.
  Inventory as of this Action Requested Previously Approved
07/31/2008 07/31/2008 06/30/2005
1,350 0 350
2,750 0 1,750
0 0 0
Used to determine if a malpractice payment is related to substandard care, professional incompetence or misconduct as well as to systematically screen and review qualifications and other credentials such as licensure, education, training, past experience, current competence and health status of doctors, dentists and other healthcare professionals.
None
None
No
1
IC Title Form No. Form Name
National Practitioner Data Bank (NPDB) Regulations & VAF 10-0376a, Credentials Transfer Brief 10-0376A
  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 1,350 350 0 0 1,000 0
Annual Time Burden (Hours) 2,750 1,750 0 0 1,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/14/2005