Form 20 Self-Query on an Organization

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

20 SelfQueryOrganization

Self-Query on an Organization

OMB: 0915-0126

Document [pdf]
Download: pdf | pdf
Non‐visible Questions 
Label 
Completion Date 

To the right of “Completed?” 

Response 
Input Item 
Text box 

DEA (Drug Enforcement 
Agency) 
FEIN (Federal Employer 
Identification Number) 
FDA (Food and Drug 
Administration) 
 
State Change 
Label 
Password Rules 

Below “NPI” 

 

Location 

Visibility Trigger 

Other 
"yyyy" hint text in text box 

Text box 

If user selects "Yes" option in 
response to "Completed?" 
If user selects DEA checkbox 

Below “DEA” 

Text box 

If user selects FEIN checkbox 

 

Below “FEIN” 

Text box 

If user selects FDA checkbox 

 

Item Type 
Info box 

Visibility Trigger 
When "view rules" is clicked, or when the “Password” text box is 
selected, the Password Rules info box shown in the 
SQFormPassword PDF appears. 

 


File Typeapplication/pdf
AuthorJClift
File Modified2014-12-17
File Created2014-12-17

© 2024 OMB.report | Privacy Policy