30 Reconciling Missing Actions_0915-0126

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

Reconciling Missing Actions_0915-0126

OMB: 0915-0126

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Non-visible Questions
Label

PDF Name
(step)

Location

Response
Input
Item

Visibility Trigger

Other

Report DCN
Number

Reconciling Below Report the
Missing
action now
Actions (1)

Text
Entry

If the user selects
Also displays
“Already reported Additional
the action” the text Comments
entry is displayed

Additional
Comments

Reconciling Below Report DCN
Missing
Number
Actions (1)

Text
Entry

If the user selects
Also displays
“Already reported Report DCN
the action” the text Number
entry is displayed

Please
describe why
this action is
not reportable

Reconciling Below Action is not
Missing
reportable
Actions (1)

Text
entry

If the user selects
“Action is not
reportable” the
text entry is
displayed

None

Reconciling Below Ask my
Missing
compliance officer a
Actions (1) question

Text
entry

If the user select
“Ask my
compliance officer
a question the text
entry is displayed

State Changes
Label
OMB Number:
0915-0126
Expiration
Date:
mm/dd/yyyy

PDF Name
Reconciling
Missing Actions

Item Type
Modal

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


File Typeapplication/pdf
File TitleReconciling Missing Actions
SubjectNPDB forms
AuthorHealth Resources and Services Administration
File Modified2020-11-19
File Created2020-06-29

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