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Credentialing by Proxy Intake Form
Indian Health Service Medical Staff Credentials Application
OMB: 0917-0009
IC ID: 261338
OMB.report
HHS/IHS
OMB 0917-0009
ICR 202307-0917-001
IC 261338
( )
Documents and Forms
Document Name
Document Type
Form 0917-0009
Credentialing by Proxy Intake Form
Form and Instruction
0917-0009 Cred by Proxy
IHS Credentialing by Proxy Intake Form 06 26 2023 FINAL.pdf
Form and Instruction
Information Collection (IC) Details
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