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Request for Dispute Resolution
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: 45 CFR Part 60 Regulations and Forms
OMB: 0915-0126
IC ID: 206502
OMB.report
HHS/HSA
OMB 0915-0126
ICR 202310-0915-003
IC 206502
( )
Documents and Forms
Document Name
Document Type
Form 23
Request for Dispute Resolution
Form and Instruction
23 Request for Dispute Resolution.pdf
Request for Dispute Resolution.pdf
Form and Instruction
Information Collection (IC) Details
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