REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER

Forms and Documents

Document Name	Status
Form 10-0449A REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER Form	New
Vets Verification process for an organization requesting NPI.doc Supporting Statement B	2007-09-14
justification (3)[1].OMB.doc Supporting Statement A	2007-06-27

IC Document Collections

IC ID	Document Title	Status
179986	REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER Form	New

ICR Details

OMB Control No: 2900-0702	ICR Reference No: 200705-2900-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: 2900-New
Title: REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/17/2007
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/20/2007
	Date Received in OIRA: 06/27/2007
Terms of Clearance: Approved consistent with VA memo clarifying security provisions used to ensure protection of NPI data.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2008	6 Months From Approved
Responses	200	0	0
Time Burden (Hours)	10	0	0
Cost Burden (Dollars)	3	0	0

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Abstract: Health care providers for veterans in the private sector (non-VA providers) are asking local VA medical centers for the National Provider Identifier (NPI) numbers for VA facilities and VA clinicians who have referred patients to them. The non-VA providers need these NPIs in order to receive payments from Medicare or other payers. The consequence of VA’s not providing this information is that these non-VA providers cannot get the Medicare payments and other insurance payments they deserve; some have indicated that if NPIs are not furnished, they may refuse to take care of our veterans.

Emergency Justfication: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires, as of May 23, 2007, that large payers and all health care providers use the new National Provider Identifiers (NPIs) for health care organizations and individual practitioners on all HIPAA-standard electronic health care transactions, which include reimbursement claims.

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Authorizing Statute(s): PL: Pub.L. 104 - 191 1174 Name of Law: HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996
  

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:
	72 FR 123	06/27/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER	10-0449A	REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER

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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	200	0	200	0	0	0
Annual Time Burden (Hours)	10	0	0	10	0	0
Annual Cost Burden (Dollars)	3	0	0	3	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: This is a new collection. The HIPAA legislation was passed in 1996 and included provisions that are implemented at later dates. The need for the National Provider Number was one of these. VHA has complied by acquiring NPIs for all facilities and clinicians. In the past month VHA field stations began receiving requests from outside health care providers for NPI numbers for referring facilities and clinicians in order to complete their claim processes. VHA was not aware of this need until requested by the outside entities. To simplify the process for providing this information VHA developed VA Form 10-0499A. Because this form collects data from private sector businesses it needs OMB approval.

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Annual Cost to Federal Government: $424

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? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

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)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 06/27/2007

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