Document
State Licensing Board Attestation
ICR 202610-0906-006 · OMB 0906-0081 · Object 174168900.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | State Licensing Board Attestation |
| Last Modified By | Adobe Acrobat (64-bit) 26.1.21431 |
| File Modified | 2026-06-29 |
| File Created | 2026-04-28 |
| Conversion State | complete |
Extracted Text
State Licensing Board Attestation Form and Instruction
Non-visible Questions
Label
PDF Name
(step)
Why are you
removing this
profession?
Location
Response
Input
Item
Visibility Trigger
State
Licensing
Board
Attestation
(1)
Under Profession Drop List
Name
If the user unchecks
the checkbox in a
row, then the field
is displayed.
Additional
Professions
State
Licensing
Board
Attestation
(1)
Below Add a
Text Entry
Profession if
your board
regulates a
profession that is
not listed”
If the user adds a
profession from the
modal that requires
a description then
the field is
displayed.
+Description
(optional)
State
Licensing
Board
Attestation
(1)
Beside
Additional
Profession
Text Entry If the user adds a
profession from the
modal, an
additional optional
field is displayed.
Why are you
unable to
attest?
State
Licensing
Board
Attestation
(2)
Below the Yes
No button in a
table row
Text Entry When the user
selects No for “Can
you attest” for a in a
row, then the field
is displayed.
Why not?
State
Licensing
Board
Attestation
(2)
Below the Yes
and No radio
buttons after
Querying
Confidentiality
Text Entry The field is
displayed if the user
selects the No radio
button
Other
State Changes
Label
PDF Name
OMB Number:
0906-0081
Expiration
Date:
mm/dd/yyyy
State Licensing
Board Attestation
Modal
When the user selects the link the modal is displayed
with the public burden statement content.
Select an
Occupation or
Field of
Licensure
State Licensing
Board Attestation
(1)
Modal
When the user selects the link “+ Add a profession”
the modal to select a profession is displayed and
focus is set on the Search text entry. The user can
enter text in the Search text box to find a specific
profession or select a profession from the list
without searching. The modal is hidden once the
user selects a profession from the list. The user's
selection adds the selected profession to the list
under “Additional Profession(s)”
Item Type
Trigger