Information Collection Request

Indian Health Service Medical Staff Credentials and Privileges Files

ICR 201306-0917-001 · OMB 0917-0009 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0917-0009-1 Indian Health Service Medical Staff Credentials and Privileges Files Form and Instruction Modified Repair queued
Form 0917-009-15 Pathology Form and Instruction Modified Available
Form 0917-0009-14 Radiology Form and Instruction Modified Available
Form 0917-0009-13 Podiatry Form and Instruction Modified Available
Form 0917-0009-12 Audiology Form and Instruction Modified Source copy available
Form 0917-0009-11 Psychology Form and Instruction Modified Available
Optometry Form Removed Repair queued
Form 0917-0009-9 Dental Privileges Form and Instruction Modified Repair queued
Form 0917-0009-8 Anesthesis Form and Instruction Modified Available
Form 0917-0009-7 Psychiatry Form and Instruction Modified Available
Form 0917-0009-6 Surgery Form and Instruction Modified Available
Form 0917-0009-5 OB-GYN Form and Instruction Modified Repair queued
Form 0917-0009-4 Medical Privileges Request Form Form and Instruction Modified Source copy available
Form 0917-0009-3 Reaapointment Request Form and Instruction Modified Available
Form 0917-0009-2 Reference Letter Form and Instruction Modified Repair queued
60 Day FR Publication 04-02-13.pdf Supplementary Document Uploaded 2013-05-14 Repair queued
OMB 0917-0009 Supporting Statement 5-23-2013.docm Supporting Statement A Uploaded 2013-06-05 Available
IC Document Collections
IC IDCollectionTypeStatusForm
6568 Indian Health Service Medical Staff Credentials and Privileges Files Form and Instruction Modified
46256 Pathology Form and Instruction Modified
46255 Radiology Form and Instruction Modified
46254 Podiatry Form and Instruction Modified
46253 Audiology Form and Instruction Modified
46252 Psychology Form and Instruction Modified
46251 Optometry Form Removed
46250 Dental Privileges Form and Instruction Modified
46249 Anesthesis Form and Instruction Modified
46248 Psychiatry Form and Instruction Modified
46247 Surgery Form and Instruction Modified
46246 OB-GYN Form and Instruction Modified
46245 Medical Privileges Request Form Form and Instruction Modified
46244 Reaapointment Request Form and Instruction Modified
46243 Reference Letter Form and Instruction Modified
ICR Details
0917-0009 201306-0917-001
Historical Active 201004-0917-003
HHS/IHS 18529
Indian Health Service Medical Staff Credentials and Privileges Files
Revision of a currently approved collection   No
Regular
Approved without change 08/16/2013
Retrieve Notice of Action (NOA) 06/18/2013
  Inventory as of this Action Requested Previously Approved
08/31/2016 36 Months From Approved 08/31/2013
3,068 0 3,089
1,784 0 1,791
0 0 0

National health care standards developed by the Center for Medicare and Medicaid Services (CMS), the Joint Commission and other accrediting organizations require health care facilities to review, evaluate and verify the credentials, training and experience of medical staff applicants prior to granting medical staff privileges. To meet these standards, IHS health care facilities require all medical staff applicants to provide information concerning their education, training, licensure, and work experience and any adverse disciplinary actions taken against them. This information is then verified with references supplied by the applicant and may include: former employers, educational institutions, licensure and certification boards, the American Medical Association, the Federation of State Medical Boards, the National Practitioner Data Bank, and the applicants themselves.

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
  
None

Not associated with rulemaking

  78 FR 19721 04/02/2013
78 FR 36198 06/17/2013
Yes

  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 3,068 3,089 0 0 -21 0
Annual Time Burden (Hours) 1,784 1,791 0 0 -7 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$202,500
No
Yes
No
No
No
Uncollected
Tamara Clay 301 443-4750 [email protected]

  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.
06/18/2013