Survey of Eligible Users of the National Practitioner Databank

Forms and Documents

Document Name	Status
Form 2 User Non-User Survey Form and Instruction	New
Form 1 Self-Query Survey Form and Instruction	New
OMB_Part_B.docx Supporting Statement B	2013-07-03
Exhibit 7.docx Supplementary Document	2013-07-03
Exhibit 6.docx Supplementary Document	2013-07-03
Exhibit 5.docx Supplementary Document	2013-07-03
Exhibit 4.docx Supplementary Document	2013-07-03
Exhibit 3.docx Supplementary Document	2013-07-03
Exhibit 2.docx Supplementary Document	2013-07-03
Exhibit 1.docx Supplementary Document	2013-07-03
Glossary.docx Supplementary Document	2013-07-03
Codebook.docx Supplementary Document	2013-07-03
OMB_Part_A.docx Supporting Statement A	2013-07-03

IC Document Collections

IC ID	Document Title	Status
207742	User Non-User Survey Form and Instruction	New
207741	Self-Query Survey Form and Instruction	New

ICR Details

OMB Control No: 0915-0366	ICR Reference No: 201307-0915-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No: 19871
Title: Survey of Eligible Users of the National Practitioner Databank
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/16/2013
	Date Received in OIRA: 07/11/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	36 Months From Approved
Responses	16,400	0	0
Time Burden (Hours)	4,951	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this survey is to assess the overall satisfaction of the eligible users of the NPDB. This survey will evaluate the effectiveness of the NPDB as a flagging system, source of information, and use in decision making. Furthermore, this survey will collect information from eligible non-users of the NPDB/HIPDB to understand what can be done to aid the eligible non-users in registering, accessing, and using the information available.

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Authorizing Statute(s): PL: Pub.L. 100 - 93 1921 Name of Law: Social Security Act
   PL: Pub.L. 104 - 191 1128E Name of Law: Social Security Act
   PL: Pub.L. 111 - 148 6403 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 99 - 660 11101 Name of Law: Health Care Quality Improvement 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:
	77 FR 76052	12/26/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 41409	07/10/2013
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
Self-Query Survey	1	Self-Query Survey
User Non-User Survey	2	User Non-User Survey

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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	16,400	0	0	16,400	0	0
Annual Time Burden (Hours)	4,951	0	0	4,951	0	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: This is a new information collection.

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Annual Cost to Federal Government: $322,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? Yes

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? 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: 07/11/2013

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