Download:
pdf |
pdf Non-visible Questions
Label
Why
not?
PDF Name
(step)
Location
Authorized
Agent
Attestation (1)
Response
Input Item
Below the Yes Text Entry
and No radio
buttons
Visibility Trigger
Other
The field is displayed
if the user selects the
No radio button
State Changes
Label
PDF Name
Item Type
OMB Number:
0915-0126
Expiration Date:
mm/dd/yyyy
Authorized Modal
Agent
Attestation
Trigger
When the user selects the link the
modal is displayed with the public
burden statement content.
| File Type | application/pdf |
| File Title | Authorized Agent Attestation |
| Subject | NPDB attestation |
| Author | Health Resources and Services Administration |
| File Modified | 2020-11-19 |
| File Created | 2020-07-29 |