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State Licensing Board Attestation
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: 206507
OMB.report
HHS/HSA
OMB 0915-0126
ICR 202310-0915-003
IC 206507
( )
Documents and Forms
Document Name
Document Type
Form 28
State Licensing Board Attestation
Form and Instruction
28 State Licensing Board Attestation.pdf
State Licensing Board Attestation.pdf
Form and Instruction
Information Collection (IC) Details
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