Request For National Provider Identification Number

REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0702 can be found here:

Documents and Forms

Document Name Document Type
Form 10-0449A REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER Form
10-0449A REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER 10-0449A-fill.pdf http:www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER	Agency IC Tracking Number:	2900-New

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 162

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-0449A	REQUEST FOR NATIONAL PROVIDER IDENTIFICATION NUMBER	10-0449A-fill.pdf	http:www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200	0
Annual IC Time Burden (Hours)	10	0	10
Annual IC Cost Burden (Dollars)	3	0	3

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.