OMB control number
Indian Health Service Medical Staff Credentials Application
OMB 0917-0009 · HHS/IHS.
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.
The latest form for Indian Health Service Medical Staff Credentials Application expires 2027-07-31 and can be found here.
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Supporting Statement A |
Form 0917-0009 Peer Reference Verification
Form 0917-0009 Credentialing by Proxy Intake Form
Peer Reference Verification Initial Application to Medical Staff with Signature Documents
Federal Enterprise Architecture: Health - Health Care Services
| Form 0917-0009 | IHS Medical Staff - Initial Application | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.