Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0984 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10175 Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System Form and Instruction
CMS-10175 ELECTRONIC FILE INTERCHANGE ORGANIZATION (EFIO) CERTIFIC cms10175 (NPPES).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10175	ELECTRONIC FILE INTERCHANGE ORGANIZATION (EFIO) CERTIFICATION STATEMENT	cms10175 (NPPES).pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	100	-900	1,000
Annual IC Time Burden (Hours)	300	-2,700	3,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.