National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0931 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10114 National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406 Form and Instruction
CMS-10114 NPI Application/Update Form DRAFT - Revised CMS-10114 (08082011 without watermark).pdf Form and Instruction
Revised NPI Application Changes Table 07152011.doc Crosswalk IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 162.408 45 CFR 142.408 45 CFR 162.406

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10114	NPI Application/Update Form	DRAFT - Revised CMS-10114 (08082011 without watermark).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53,040	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	53,040	17,160	35,880
Annual IC Time Burden (Hours)	17,680	5,720	11,960
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	Revised NPI Application Changes Table 07152011.doc	11/30/2011

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