33 Electronic Funds Transfer (EFT) Authorization_0915-0126.

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: 45 CFR Part 60 Regulations and Forms

Electronic Funds Transfer (EFT) Authorization_0915-0126

OMB: 0915-0126

Document [pdf]
Download: pdf | pdf
State Changes
Label
OMB Number:
0915-0126
Expiration
Date:
mm/dd/yyyy

PDF Name

Item Type

Electronic Transfer Modal
of Funds (EFT)
Authorization

Trigger
When the user selects the link the modal is displayed
with the public burden statement content.


File Typeapplication/pdf
File Modified2020-11-19
File Created2020-06-29

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