National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406 (CMS-10114)

Forms and Documents

Document Name	Status
Form CMS-10114 National Provider Identifier (NPI) Application Form and Instruction	Modified
Form CMS-10114 National Provider Identifier (NPI) Application and Update Form Form and Instruction	Modified
Justification for CMS-10114 Section 3D error correction - 11182015.docx Justification for No Material/Nonsubstantive Change	2015-12-11
Revised NPI Application Changes Table.pdf Supplementary Document	2015-01-16
CMS-10114.Supporting Statement Part A.docx Supporting Statement A	2015-01-16

IC Document Collections

IC ID	Document Title	Status
37925	National Provider Identifier (NPI) Application Form and Instruction	Modified
179125	National Provider Identifier (NPI) Application and Update Form Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0931	ICR Reference No: 201512-0938-003
Status: Historical Active	Previous ICR Reference No: 201501-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
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 (CMS-10114)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/18/2016
	Date Received in OIRA: 12/11/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	03/31/2018	03/31/2018
Responses	608,880	0	608,880
Time Burden (Hours)	202,960	0	202,960
Cost Burden (Dollars)	0	0	0

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Abstract: The National Provider Identifier (NPI) Application and Update Form is used by health care providers to apply for NPIs and furnish updates to the information they supplied on their initial applications. The form is also used to deactivate their NPIs if necessary. The form is available on paper or can be completed via a web-based process. An NPI is expected to last for the "life" of the health care provider (i.e., until the death of an individual or until the dissolution of an organization); therefore, a health care provider applies for an NPI only one time. A health care provider must furnish updates to the required information given in the application whenever changes occur to those data. Updates can be mailed or submitted electronically.

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Authorizing Statute(s): None

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:
	79 FR 54725	09/12/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 2429	01/16/2015
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
National Provider Identifier (NPI) Application and Update Form	CMS-10114	NPI Application and Update Form
National Provider Identifier (NPI) Application	CMS-10114	NPI Application

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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	608,880	608,880	0	0	0	0
Annual Time Burden (Hours)	202,960	202,960	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? No

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: 12/11/2015

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