Form 33 Electronic Funds Transfer (EFT) Authorization

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

Electronic Transfer of Funds (EFT) Authorization

OMB: 0915-0126

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Electronic Funds Transfer (EFT) Authorization Form and Instruction
File Typeapplication/pdf
File TitleElectronic Funds Transfer (EFT) Authorization
AuthorHealth Resources and Services Administration
File Modified2023-05-31
File Created2023-01-18
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