Indian Health Service Medical Staff Credentials Application

OMB Control No: 0917-0009	ICR Reference No: 202002-0917-002
Status: Active	Previous ICR Reference No: 201607-0917-001
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
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/25/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/27/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	36 Months From Approved	08/31/2020
Responses	2,700	0	3,068
Time Burden (Hours)	1,400	0	1,784
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is used to evaluate individual health care providers applying for medical staff credentials at IHS health care facilities. Provider credentialing in the IHS has been identified as a priority area for quality improvement to support patient safety and demonstrate quality of care. 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. The IHS is transforming credentialing into a centrally installed, automated, standardized, electronic/digital, measurable, portable, accessible, and efficient business process to improve the effectiveness of application and re-application to Medical Staffs, movement of practitioners within the IHS system, and recruitment/retention of high-quality practitioners.

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Authorizing Statute(s): US Code: 25 USC 450 Name of Law: Indian Self-Determination and Education Act    US Code: 25 USC 13 Name of Law: Synder Act    US Code: 42 USC 2001-2004 Name of Law: IHS Transfer Act

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 70197	12/20/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 10705	02/25/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title Form No. Form Name Psychology 0917-0009-11 OMB 0917-0009-11, Psychology Privileges Request Form Audiology 0917-0009-12 OMB No. 0917-0009-12, Audiology Privileges Request Form Podiatry 0917-0009-13 OMB Form No. 0917-0009-14, Podiatric Privileges Request Form Radiology 0917-0009-14 OMB No. 0917-0009-14, Radiolgy Privileges Request Form Pathology 0917-009-15 OMB No. 0917-0009-15, Pathology Privileges Request Form Medical Privileges Request Form 0917-0009-4 0917-0009-4, Medical Privileges Request Form Reference Letter 0917-0009-2 0917-0009-2, References Form OB-GYN 0917-0009-5 0917-0009-5, OB-GYN Privileges Form Surgery 0917-0009-6 0917-0009-6, Surgical Privileges Request Form Psychiatry 0917-0009-7 0917-0009-7, Psychiatric Privileges Request Form Anesthesis 0917-0009-8 0917-0009-8, Anesthesia Privileges Request Form Reaapointment Request 0917-0009-3 0917-0009-3, Reappointment Request Form Initial Application to Medical Staff with Signature Documents 0917-0009 IHS Medical Staff - Initial Application Reappointment Application 0917-0009 IHS MEDICAL STAFF - REAPPOINTMENT APPLICATION Indian Health Service Medical Staff Credentials and Privileges Files 0917-0009-1 Application for Medical Staff Appointment and/or Privileges Dental Privileges 0917-0009-9 0917-0009-9, Dental Privleges Request Form

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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	2,700	3,068	0	2,700	-3,068	0
Annual Time Burden (Hours)	1,400	1,784	0	1,400	-1,784	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: No

Burden Reduction Due to:

Short Statement: The new credentialing system is completely electronic and streamlines the credentialing process for providers.

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Annual Cost to Federal Government: $2,360,000

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 [email protected]

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Common Form ICR:  No

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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: 02/27/2020

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