Electronic Transfer of Funds (EFT) Authorization

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: 214935

Documents and Forms

Document Name Document Type
Form 33 Electronic Transfer of Funds (EFT) Authorization Form and Instruction
33 Electronic Funds Transfer (EFT) Authorization.pdf Electronic Funds Transfer (EFT) Authorization.pdf Form and Instruction