National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract

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

0126 Forms 2007

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Pract

OMB: 0915-0126

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Entity Registration








Agent Registration




Entity Registration Update






Agent Registration Update





Entity Registration Renewal





Agent Registration Renewal






Initial AAR











Correction AAR










Correction Legacy AAR







Revision to Action AAR








Explicit Query









Subject Database (individual)








Subject Database (organization)




Self Query (individual)








Self Query Organization







Subject Dispute




Secretarial Review





Authorized Agent Designation




Authorized Agent Designation (update)



Electronic Fund Transfer Authorization


Account Discrepancy Form


Initial Accreditation


Accreditation Correction


Accreditation Revision


QIO Initial


QIO Correction


QIO Revision to Action



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File Typeapplication/msword
File TitleEntity Registration
AuthorHRSA
Last Modified ByHRSA
File Modified2007-05-07
File Created2007-05-07

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