Information Collection

Request For National Provider Identification Number

IC 179986 under ICR 200712-2900-010 · OMB 2900-0702.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0449A REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER	Form
10-0449A REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER 10-0449A-fill.pdf http:www.va.gov/vaforms	Form

IC Title:

REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER

Agency IC Tracking Number:

2900-0702

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 162

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-0449A	REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER	10-0449A-fill.pdf	http:www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	0	200
Annual IC Time Burden (Hours)	10	0	10
Annual IC Cost Burden (Dollars)	0	-3	3

Documents for IC

table that charts IC Documents
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.