Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: 45 CFR Part 60 Regulations and Forms

Documents and Forms

Document Name Document Type
Form 1 Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal Form and Instruction
1 Correction Revision-to-Action Void Notice of Appeal Correction, Revision-to-Action, Void, Notice of Appeal.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Correction, Revision to Action, Correction of Revision to Action, Void, Action on Appeal	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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	1	Correction Revision-to-Action Void Notice of Appeal	Correction, Revision-to-Action, Void, Notice of Appeal.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: System of Record Notice 09-15-0054	FR Citation: 88 FR 17854

Number of Respondents: 23,879	Number of Respondents for Small Entity: 10,000

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	23,879	-6,340	30,219
Annual IC Time Burden (Hours)	2,230	-755	2,985
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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