Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

Documents and Forms

Document Name Document Type
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction
1 Query Survey Intro-Instructions Query Survey Intro-Instructions - FINAL_For Clearance.docx Form and Instruction
1 Query Survey Intro-Instructions Query Survey Intro-Instructions - FINAL_For Clearance.docx Form and Instruction
2 User Survey Questions - Query User Survey Questions - Query_FINAL_For Clearance.docx Form and Instruction
2 User Survey Questions - Query User Survey Questions - Query_FINAL_For Clearance.docx Form and Instruction
OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance.docx OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance IC Document
OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance.docx OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance IC Document

Information Collection (IC) Details

IC Title:	Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms	Agency IC Tracking Number:

IC Status: New

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	1	Query Survey Intro-Instructions	Query Survey Intro-Instructions - FINAL_For Clearance.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	User Survey Questions - Query	User Survey Questions - Query_FINAL_For Clearance.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	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: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance	OMB Fast Track Memo_Infostatica_Request for Approval_Query Survey FINAL_For Clearance.docx	01/09/2024

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