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Form 39 Account Balance Transfer_0915-0126
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: 45 CFR Part 60 Regulations and Forms
Account Balance Transfer_0915-0126
Account Balance Transfer
OMB: 0915-0126
OMB.report
HHS/HSA
OMB 0915-0126
ICR 202101-0915-002
IC 229941
Form 39 Account Balance Transfer_0915-0126
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0915-0126 can be found here:
2023-11-09 - Revision of a currently approved collection
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File Type
application/pdf
File Title
Account Balance Transfer
Subject
NPDB form
Author
Health Resources and Services Admnistration
File Modified
2020-11-19
File Created
2020-07-29
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